Physiotherapy Resource Allocation for Reducing Progression of Frailty in Acute Care: Getting It Right Requires Measuring It Right

Research Objectives: To address the demands of an aging patient population, hospitals need to embark on service model redesign. Redesigns require robust metrics to guide decision-making in staffing and skill mix. However, data quantifying utilization of health discipline services such as physiotherapy (PT) in acute care is limited. The objective of this study is to explore changing trends in patient demographics and enhanced PT workload data to inform recommendations on resource adjustments needed to meet the needs of older adults admitted to acute medicine inpatient units.

Design: A mixed-methods study including a retrospective medical record review and PT focus groups to contextualize workload data.

Setting: Acute medicine inpatient unit in a tertiary care teaching hospital in London, Ontario, Canada.

Participants: 1823 inpatient medical records in 2018 and 1908 inpatient medical records in 2022 were reviewed for the retrospective review and 5 physiotherapy providers were interviewed for the focus groups.

Interventions: A retrospective review of the Electronic Medical Record (EMR) and Hospital Workload Measurement System (WMS) was conducted to describe and compare patient characteristics and PT workload in 2018 and 2022. Two focus groups comprised of four physiotherapists and one physiotherapist assistant were conducted to further explore and contextualize PT workload data.

Main Outcome Measures: Patient demographic data included age, sex, length-of-stay (LOS) and major clinical category of the admitting diagnosis. PT workload data included metrics reflecting quantity, frequency and intensity of PT service provided.

Results: The number of patients who received PT services during hospitalization in 2018 and 2022 did not change. Statistically significant increases were seen in mean patient’s age (77 to 78 years, p=0.005) and median LOS (7.8 to 9.7 days, p< 0.001). Significant increases were also seen in average PT service hours provided per day (17.1 to 25.0 hours, p< 0.001), and average total PT service hours provided per patient (3.43 to 4.76 hours, p< 0.0001). The average number of PT interactions per patient increased (7.16 to 9.15, p< 0.0001), as did the number of patients requiring multiple PT interactions in a day (51% of patients in 2018 and 58% of patients in 2022 (p < 0.0005)).

Conclusions: This study provides comprehensive metrics demonstrating shifts in rehabilitative needs of acute medicine inpatients. Despite stable patient volumes, patient care needs substantially increased. Collecting the right measures – those that reflect the authentic PT experiences – are needed to inform appropriate change and ensure proper resource allocation.

Author(s) Disclosures: The authors have neither individual nor group competing interests applicable to this work.