Rosentel, Joshua, BSN, RN

Sawyer PT, DPT, Daniel

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Posters Uniting Physical Therapy and Emergency Medicine to Reduce Admissions Joshua Rosentel BSN, RN Daniel Sawyer PT, DPT Follow this and additional works at: https://scholarlyworks.lvhn.org/posters  Part of the Medicine and Health Sciences Commons This Article is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Lehigh Valley Health Network, Allentown, PennsylvaniaReferences• Magel J, Kim J, Fritz JM, Freburger JK. Time Between an Emergency Department Visit and Initiation of Physical Therapist Intervention: Health Care Utilization and Costs. Phys Ther. 2020 Sep 28;100(10):1782-1792. doi: 10.1093/ptj/pzaa100. PMID: 32478851; PMCID: PMC7530572.• Gurley KL, Blodgett MS, Burke R, Shapiro NI, Edlow JA, Grossman SA. The utility of emergency department physical therapy and case management consultation in reducing hospital admissions. J Am Coll Emerg Physicians Open. 2020 Jun 26;1(5):880-886. doi: 10.1002/emp2.12075. PMID: 33145536; PMCID: PMC7593441.Outcomes• While several metrics have shown benefits, LVHN continues to experience a high admission rate for back pain patients• FY2021 Q1 and Q2 CDB reports continue to show LVHN as having high admission rates for MS DRG 551 & 552 compared to other AMCs.• LVHN recognizes PT in the ED algorithm as a necessary tool for better patient care. With the tapering of COVID-19 admissions, LVHN is experiencing its highest rates of PT evaluations for back pain patients since the start of our project. • Rapid evaluation by PT in the ED allows for a shorter arrival to evaluation time and a reduction in unnecessary diagnostic imaging.Learning Objectives• Examine the implementation of an emergency department-based physical therapy evaluation algorithm to reduce admissions relating to common musculoskeletal conditions.• Use the Vizient Clinical Data Base (CDB) to benchmark hospital data against an appropriate comparison cohort for quality improvement.Background• Utilizing CMS reporting, the Vizient Clinical Data Base (CDB), and evidence-based research, an emergency department (ED) back pain protocol was developed involving early intervention by physical therapy (PT).• Lehigh Valley Health Network (LVHN) is a consistent high outlier for medical back pain admissions as per the CMS PEPPER report• Confirmed using the CDB by comparing LVHN against other academic medical centers for MS DRG 551 and 552 admissions as well as PT utilizationsUniting Physical Therapy and Emergency Medicine to Reduce AdmissionsJoshua Rosentel, BSN, RN, CPHQ, Clinical Quality Information Expert, Daniel Sawyer, PT, DPT, Physical TherapistUCLCLLCL-2%0%2%4%6%8%10%12%14%19-Jul 19-Aug 19-Sep 19-Oct 19-Nov 19-Dec 20-Jan 20-Feb 20-Mar 20-Apr 20-May 20-Jun 20-Jul 20-Aug 20-Sep 20-Oct 20-Nov 20-Dec 21-Jan 21-Feb 21-Mar 21-Apr 21-May 21-Jun 21-JulED PT Evaluation %Treatment Classification§ Mobilization§ Stabilization§ Direction Preference Patient with back pain in EDProvider consults PT for evaluation & treatmentPT in the ED Low Back PainPT sees patient within 90 minPT evaluates patientPT communicates finding to ED providerTreat patientPatient dispositioned accordinglyPatient atCedar Crest8:00a-6:00p7 days per weekYESNOProvide symptom controlImproved + able to ambulateOBVProvider places Ambulatory Referral to Advanced Spine CenterNOYESPT Documentation§ Acute care team will create inpatient template that correlates with outpatient documentation§ Long term plan to create an outpatient department within the ED where acute care therapists will complete “outpatient” evaluationsStandardized Measures§ OSWESTRY§ Fear Avoidance§ KEELE START Back toolConsider chiropractic ambulatory visit referralED provider and PT to discuss referral to outpatient PT- if ED provider amenable to referral, ED provider will sign PT care plan (will appear in provider’s epic inbox). PT will direct schedule patient for PT follow up during ED visit. Note: Advanced Spine Center triages patients to appropriate care including potential evaluation by:§ Physiatry§ Pain Management§ Orthopedics§ Neurosurgery§ Physical therapy§ Chiropractic medicine38.00%40.00%42.00%44.00%46.00%48.00%50.00%Admission Unit PT Eval ED PT EvalDiagnostic X-Ray Utilization051015202530354045Admission Unit PT Eval ED PT EvalArrival to PT Evaluation Time (hrs.)Speaker Contact Information• Joshua Rosentel – joshua.rosentel@lvhn.org• Daniel Sawyer – daniel.sawyer@lvhn.org• Lehigh Valley Health Network1200 S. Cedar Crest Blvd.Allentown, PA 18103(610) 402-4000• The authors of this presentation have nothing to disclose 

Uniting Physical Therapy and Emergency Medicine to Reduce Admissions

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Uniting Physical Therapy and Emergency Medicine to Reduce Admissions

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Lehigh Valley Health Network: LVHN Scholarly Works