What is the role of a physical therapist (PT) in discharge planning?

The Role of Physical Therapists in Discharge Planning

Physical therapists play a critical role in discharge planning by conducting functional assessments, making appropriate discharge recommendations, and ensuring patient safety post-discharge, which significantly reduces mortality and morbidity risks when their recommendations are implemented.

Key Functions of Physical Therapists in Discharge Planning

Assessment and Evaluation

• Conduct comprehensive functional assessments to determine patient's mobility status, balance, strength, and overall physical capabilities 1
• Evaluate fall risk prior to discharge (implementation of this assessment can increase identification of at-risk patients from 6.3% to 94.8%) 2
• Assess patients' ability to perform activities of daily living and instrumental activities of daily living 1
• Determine the need for assistive devices, adaptive equipment, and home modifications 1

Discharge Recommendations

• Make evidence-based recommendations for appropriate discharge location (home, rehabilitation facility, skilled nursing facility) 3
• When physical therapists' discharge recommendations are implemented, patients are 59% less likely to fall during the month after hospital discharge 4
• Patients whose discharge recommendations from physical therapists are not implemented are 2.9 times more likely to be readmitted 3

Interdisciplinary Collaboration

• Participate in weekly formal interprofessional team meetings to identify rehabilitation problems, set goals, monitor progress, and plan post-discharge support 1
• Collaborate with occupational therapists who conduct home assessments to identify necessary modifications for accessibility and safety 1
• Work with the entire healthcare team to formulate goal-oriented discharge plans and target discharge dates 1

Patient and Caregiver Education

• Provide education and training to caregivers on proper techniques for assisting patients with mobility and transfers 1
• Train patients and families on proper use of assistive devices and adaptive equipment 1
• Educate on home exercise programs to maintain and improve functional gains 1

Home and Community Transition Planning

• Conduct pre-discharge home visits when there are concerns about functional, communication, or cognitive abilities that may affect patient safety 1
• Participate in early supported discharge (ESD) programs, which have been shown to reduce the odds of death or dependency (OR = 0.82,95% CI 0.67 to 0.97) 1
• Plan for community-based rehabilitation services to continue progress (minimum 45 minutes per day, 2-5 days per week, for at least 8 weeks) 1

Documentation and Handover

• Document comprehensive clinical handover information at discharge (implementation of standardized processes can improve quality of documentation from 34.9% to 92.9%) 2
• Include specific recommendations for follow-up therapy services 1
• Document fall risk assessment and prevention strategies 5

Common Pitfalls and How to Avoid Them

1. Failure to identify fall risk:

   • Implement standardized fall risk assessments for all patients prior to discharge 2
   • Note that balance and mobility test scores alone (like POMA and AM-PAC IMSF) may not fully predict fall risk after discharge 4

2. Inadequate handover documentation:

   • Use standardized documentation processes that include specific criteria for quality handover 2
   • Ensure documentation includes functional status, equipment needs, and follow-up recommendations 1

3. Lack of caregiver preparation:

   • Include caregivers in rehabilitation sessions and training prior to discharge 1
   • Provide written instructions and resources for continued care 1

4. Insufficient home preparation:

   • Conduct home assessments before discharge when indicated 1
   • Recommend necessary home modifications and equipment 1

5. Discontinuity of care:

   • Establish clear follow-up plans with community providers 1
   • Ensure referrals to appropriate community-based rehabilitation services 1

Physical therapists' expertise in functional assessment and rehabilitation makes them essential members of the discharge planning team. Their recommendations significantly impact patient outcomes, reducing readmission rates and fall risk when properly implemented. The evidence clearly demonstrates that following physical therapist discharge recommendations leads to better patient outcomes and reduced mortality and morbidity risks.