Should doctors discharge patients from the hospital without informing the physical therapist (PT)?

Doctors Should Not Discharge Patients Without Informing Physical Therapists

Doctors should always inform physical therapists before discharging patients from the hospital to ensure proper continuity of care, reduce adverse outcomes, and improve patient safety.

Importance of Multidisciplinary Communication at Discharge

• Hospital discharge is a period of significant potential vulnerability for patients, with many failing to understand important elements of their discharge and home care plans 1
• Effective discharge communication is a key and often overlooked element in the transition process, providing an opportunity to summarize the visit, address remaining questions, and help patients connect to appropriate care providers 1
• Discharge planning should begin at admission to the hospital and be updated as projected patient needs change 1

Role of Physical Therapy in Discharge Planning

• More frequent physical therapy visits during hospitalization are associated with functional improvement and increased likelihood of discharge home 2
• Physical therapists play a crucial role in identifying patients' functional status and readiness for discharge, with validated tools like the postoperative physiotherapy discharge scoring tool (POP-DST) demonstrating strong predictive validity for patients who will not develop complications after discharge 3
• Physical therapists are important members of the multidisciplinary team needed for effective patient care, especially for patients with conditions requiring rehabilitation 1

Consequences of Poor Discharge Communication

• Physicians often overestimate patients' understanding of the post-discharge treatment plan, with significant discrepancies between what physicians believe patients understand and what patients actually report understanding 4
• Failure to communicate with all members of the healthcare team, including physical therapists, can lead to:
  • Gaps in care continuity 1
  • Increased risk of adverse events 1
  • Potential for medical errors 1
  • Reduced patient satisfaction 1

Best Practices for Discharge Communication

• Structured discharge communication should include information on medication changes, pending tests, and follow-up needs that must be accurately and promptly communicated to all relevant healthcare providers 1
• Discharge planning is not a separate entity but an important part of an overall discharge plan that should involve all members of the multidisciplinary team 1
• Patients should not be discharged from hospital without either a definite or suspected diagnosis, and arrangements for outpatient follow-up and plans for ongoing therapy and rehabilitation should be formulated at a discharge meeting 1

Specific Recommendations for Physical Therapy Communication

• All patients, regardless of age, should have access to assessment for rehabilitation before discharge, requiring communication with physical therapists 1
• Discharge summaries should be transmitted to all relevant healthcare providers, including physical therapists, as soon as possible after discharge 1
• For patients requiring ongoing physical therapy, appointment-keeping behavior is enhanced when the inpatient team schedules outpatient medical follow-up prior to discharge 1

Legal and Ethical Considerations

• Failure to communicate with physical therapists before discharge could potentially be viewed as a breach in the duty of care, especially if it leads to adverse outcomes that could have been prevented 5
• While patients have the right to refuse treatment and leave against medical advice, healthcare providers still have a duty of care that includes proper handover of information to all relevant team members 5

Ensuring proper communication with physical therapists before patient discharge is not just a matter of professional courtesy but a critical component of safe, effective, and patient-centered care that reduces the risk of adverse outcomes and improves the transition from hospital to home or other care settings.