Increasing Functional Measurement Tool Utilization by Acute Physical Therapists

Abstract

Background: At an acute academic medical center, an electronic medical record (EMR) clarity report revealed that proper documentation of a functional measurement tool during acute physical therapy (PT) initial evaluation and reevaluation sessions occurred only 12% of the time. A formal quality improvement project was initiated to correct this gap in recommended best practice. Objective: To increase utilization and documentation of functional measurement tools in acute PT evaluation and reevaluation sessions from baseline of 12% to 100% based on the APTA recommendations for best standard of care in clinical practice. Methods: This quality improvement project involved acute PT staff and faculty in an academic medical center assessing a gap in best practice. Barriers to best clinical practice were assessed and targeted interventions included education and awareness of baseline performance compared with expectations, streamlining usability of the EMR documentation flowsheet and creating resources to address gaps in knowledge, performance, or access to available functional tools. Data were collected at project initiation, midterm, and after final interventions through manual chart reviews, EMR clarity reports, and a custom PT staff survey. Results: Documentation of functional measurements tools improved from the baseline of 12% to 89.5% after full project interventions. Follow-up survey results indicated that PTs' perception of providing the highest quality of care increased by 29 percentage points, from 71% to 100%. Improved diversity of tool usage was also noted. Of the tools documented, Activity Measure for Post-Acute Care (AMPAC) functional measurement tool was selected 90% of the time at baseline and dropped to 66% post-intervention, allowing for a 24% increase in diversity of tool selection. Conclusions: Accurate discovery of the primary and secondary factors impacting tool use with targeted interventions yielded a 7.5-fold improvement (from 12% to 89.5%) in performance and documentation of functional measurement tools during PT evaluation and reevaluation sessions in the acute care setting. The project also highlighted limitations of education alone in effectively promoting adherence to best practice standards. The increased utilization and documentation of functional measurement tools has improved PT practice in this academic medical center through more objective detection of functional changes across the continuum. It should also promote targeted PT interventions, which should improve PT effectiveness and potentially even impact hospital length of stay.