DiFiore, Marcel, SPT

Fink, Amanda, SPT

Fischer, George, SPT

Jordan, Maria, SPT

Lebron, Erika, SPT

Pechulis, Michael, PT, DPT

Rieger, Alyssa, SPT

Skrzat, Julie M, PT DPT PhD CCS

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Patient Care Services / Nursing Utilization of the FSS-ICU to Assess Hospital Discharge Disposition Marcel DiFiore SPT Amanda Fink SPT George Fischer SPT Maria Jordan SPT Erika Lebron SPT See next page for additional authors Follow this and additional works at: https://scholarlyworks.lvhn.org/patient-care-services-nursing Published In/Presented At DiFiore, M. Fink, A. Fischer, G. Jordan, M. Lebron, E. Rieger, A. Pechulis, M. Skrzat, J. (2019, October). Utilization of the FSS-ICU to Assess Hospital Discharge Disposition. Presented at: 2019 (PPTA) Pennsylvania Physical Therapy Association meeting, PA. This Presentation 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. Authors Marcel DiFiore SPT; Amanda Fink SPT; George Fischer SPT; Maria Jordan SPT; Erika Lebron SPT; Alyssa Rieger SPT; Michael Pechulis PT, DPT; and Julie M. Skrzat PT DPT PhD CCS This presentation is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/patient-care-services-nursing/1216 Utilization of the FSS-ICU to Assess Hospital Discharge DispositionMarcel DiFiore SPT, Amanda Fink SPT, George Fischer SPT, Maria Jordan SPT, Erika Lebron SPT, Alyssa Rieger SPT, Michael Pechulis PT DPT, Julie Skrzat PT DPT PhD CCSAim & HypothesisAIM• To determine if there is a difference between the FSS-ICU scores acquired within 24hour of a MSICU discharge across hospital discharge locations.HYPOTHESIS• There will be a difference in FSS-ICU scores acquired within 24 hours of ICUdischarge across hospital discharge locations.ResultsMethodologyDiscussion• There was a difference in FSS-ICU scores acquired within 24 hours of ICUdischarge across hospital discharge locations, demonstrating the FSS-ICU’s abilityto discriminate between hospital discharge disposition in an acute care hospital.• Our research provided more functional and usable ranges of FSS-ICU scores. Dueto the large sample size of patients discharged home and significant results,patients can be reliably discharged home if they have a score between 28 – 35 atICU discharge.• Patients followed a linear pathway throughout their hospital length of stay in order tominimize confounding variables, allowing for a more controlled group during thestudy.LIMITATIONS• A linear pathway is not typical of most patients’ hospitalizations.• Patients self-reported independence for pre-hospital function, which likelycontributed to the majority of patients being discharged home.• Discharge planning is multifactorial. In addition to physical function, social andmedical factors also contribute to discharge planning and cannot be accounted forby the FSS-ICU outcome measure.• Power was not met, however the sample size used was larger than previouslyreported literature.FUTURE DIRECTIONS• Analysis of factors that influence discharge in patients scoring between 19 and 28• Examine a more heterogenous patient populations including• Medical and surgical management.• Prior level of function.• Examine factors that contribute to a meaningful change in FSS-ICU score including• Frequency of physical therapy visits in ICU and on ward.• Specific physical therapy interventions.References1. Huang M, Chan KS, Zanni JM, et al. Functional status score for the intensive care unit (FSS-ICU): an international clinimetric analysis of validity, responsiveness, and minimal important difference. Crit Care Med. 2016;44(12):e1155-e1164. 2. Parry SM, Denehy L, Beach LJ, Berney S, Williamson HC, Granger CL. Functional outcomes in ICU - what should we be using? - an observational study. Crit Care. 2015;19:127. doi:10.1186/s13054-015-0829-5.3. Peterson ML, Lukens K, Fulk G. Physical function measures used in the intensive care unit: a systematic review. J Acute Care Phys Ther. 2018;9(2):78-90.4. Ragavan VK, Greenwood KC, Bibi K. The Functional Status Score for the Intensive Care Unit Scale: Is It Reliable in the Intensive Care Unit? Can It Be Used to Determine Discharge Placement?. Journal of Acute Care Physical Therapy. 2016;7(3):93-100. 5. Thrush A, Rozek M, Dekerlegand JL. The clinical utility of the functional status score for the intensive care unit (FSS-ICU) at a long-term acute care hospital: a prospective cohort study. Phys Ther. 2012;92(12):1536-45. AcknowledgementsDr. Melissa Carroll, Dr. Rebecca Kudrna, Matthew Nelson PT DPT, Ryan Vetter MSOTClinical Relevance• This study builds upon previously published literature by expanding the sample bysize and medical acuity.• The FSS-ICU successfully discriminated amongst home and other dischargesettings by providing a range of scores to aid physical therapists in the clinicaldecision making of discharge disposition.• Patients who score at the higher end of the FSS-ICU scale (>28) were more likely togo home.• With a narrower range of FSS-ICU scores, allocation of physical therapy serviceswill improve based on patients’ needs.• Physical therapy services may be better allocated to patients with lower mobilityscores to increase their chances of being discharged homeIntroduction• Admission to an ICU is a life altering event that can result in functional impairments. • As a result, patients’ functional abilities and quality of life post ICU stay is decreased. • Early identification of patients at risk of developing functional impairments is valuable to allow the healthcare team greater opportunities to implement physical therapy interventions and mobility. • There are currently few mechanisms for identifying these patients, making it difficult to prioritize follow up physical therapy visits due to constrained resources or measuring effectiveness of interventions.• However, an emerging method to combat this obstacle is through the use of outcome measures.• The FSS-ICU is a reliable and valid clinical outcome measure used to evaluate a patient’s physical functioning in an ICU setting.• Currently, there is limited research looking into the ability of the FSS-ICU to assist in determining a patient’s discharge location. Total Charts Evaluated(n=2075)Excluded (n=1960)• Patients transferred to ICU from another hospital, floor, or facility • Multiple re-admissions within the same time frame • No discharge record • Adults unable to consent • Pregnant women• Prisoners Included (n = 115)• Adults over 18 years old• Direct admit from home • Self-reported functionally independent • Active PT consult • FSS-ICU ICU discharge score• Definitive discharge location  Research DesignRetrospective chart review of PI projectTime Frame10/01/2016 –09/30/2017LocationLVHN Cedar CrestPower Analysis80% (180 subjects)Two-tail significant level of .05Hospital Course ED  LVHN MSICU  Discharge locationn= 115 Data AnalysisDescriptive statisticsOne Way ANOVA Bonferroni post-hocKEY: ED: Emergency department. FSS-ICU: Functional Status Score for the Intensive Care Unit. ICU: Intensive care unit. IP: Inpatient rehabilitation. MSICU: Medical surgical intensive care unit. PI: Process improvement. PT: Physical therapy. SNF: Skilled nursing facility.  PATIENTS’ HOSPITALIZATION COURSE

Utilization of the FSS-ICU to Assess Hospital Discharge Disposition

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Utilization of the FSS-ICU to Assess Hospital Discharge Disposition

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