Poster 3 Rehabilitation Work
1
Participants: Adrian Cristian, MD, MHCM; Marc Ross, MD; Vishal Rekhala, DO; Laurentiu Dinescu, MD; Fred Aziz, MD; Ethan Egan, MD; Travis VonTobel, MD. Interventions: A multidisciplinary approach was used to iden- tify and define: a) the steps involved in the completion of consults on a consult service, b) barriers in the process, c) interventions that remove or minimize the barriers. The major barriers identified included: a) lack of prioritization of consults, b) Lack of coordinated communication between resident physi- cians, rehab office administrators and attending physicians, c) reduced opportunities for teaching of residents on consult ser- vice, and d) inaccurate workload data collected for follow-up visits on the consult service. A time study on 109 consults was carried out to determine the number of minutes needed to complete a consult by a resident. Data was also collected on the number of consults requests received by day of the week. Once identified, the interventions were implemented in a pilot pro- gram. Data collected revealed the following: a) majority of the consults occurred early in the week and b) time to complete consults ranged from 35-52 minutes. The interventions identi- fied for the pilot program were: a) addition of another resident, b) an “on-call” consult attending physician schedule, c) develop- ing a mechanism to collect data that was more reflective of all workload completed by residents on consult service, d) develop- ing and implementing a mechanism to prioritize consults, e) establishing a “cap” on the total number of consults to be completed per day by residents, and f) strategies to improve communication between all involved parties. Main Outcome Measures: Resident satisfaction survey. Results: Residents have expressed improvement in the overall quality of the consult service rotation in terms of improved super- vision, teaching and workload. Conclusions: Resident experience on a PMR consultation service can be improved through a multidisciplinary approach and using QI methodology. Poster 2 Impact of a Reproducible Complex Partnership Between Physiatry and Emergency Medicine on Spine Care. Andrew J. Haig, MD (Haig et al, Consulting, Ann Arbor, MI, United States); Katrina Diaz, BS; Sierra Loar, MPA; David Share, MD; Bradley Uren, MD. Disclosures: A. J. Haig, Ownership or partnership: Haig et al., Consulting LLC; Non-remunerative positions of influence, The International Rehabilitation Forum; The International Society for Physical and Rehabilitation Medicine; Non-remunerative positions of influence; The University of Michigan. Objective: Back pain is common and costly; often mismanaged in Emergency Departments (ED). To address this issue a complex, codified, yet reproducible process is needed. This project evaluates the impact of one such protocol, FastBack™, on emergency care of back pain. Design: Prospective trial. Setting: University hospital, large and small community hospitals. Participants: 200 consecutive university hospital adult ED pa- tients with back pain before, at onset, and 6 months after Fast- Back™ consultation. Interventions: The FastBack™ protocol includes multipronged ED staff education, patient intake forms, special PT protocols, and physiatrist agreement to see ED patients within 48 hours. ED physicians triaged patients to admission, simple discharge, physical therapy or physiatrist. The protocol was launched at the three hospitals. Data collection and storage were independent from the intervening consultant, and the final results will be verified by an independent statistical group. Main Outcome Measures: Successful execution of the pro- gram, ‘Bounce backs’ to the ED within 1 month, advanced imaging, opiate prescription, therapy and physiatry referrals. Results: All 3 hospitals successfully launchedFastBack™. How- ever, the large community hospital was research non-compliant and the small community hospital data is pending. At the university hospital, emergency department ‘bounce backs’ who returned within a month dropped from 10% to 2%. Opiate prescriptions from 40% to-28%, diazepam from 19% to 12%, and MRI scans from 11.5% to 8.5%, though there was an increase in CT scan use. PT referrals went from 0 to 23, and PM&R referrals from 13-38. Conclusions: FastBack™ is executable across diverse settings. At the university hospital, all important metrics except CT scan use moved towards improved quality of care. A complex, holistic, but codified and reproducible consultation process results in decreased returns to emergency department and shift of care to better quality for persons with low back pain. Project funded through the Center for Healthcare Research & Transformation, and supported by Blue Cross Blue Shield of Michigan and the University of Michigan. Performed independently by Haig et al., Consulting. Poster 3 Rehabilitation Work. Chennyfer P. Paim, PhD (University Nove de Julho, São Paulo, Brazil); Dayana Pinezzi, student. Disclosures: C. P. Paim, No Disclosures. Objective: To contextualize the impact and difficulties faced in the rehabilitation process of formal workers in Brazil. This is a descriptive study that was based on the methodological literature; in order to achieve a significant amount of updated information, ten articles were used. Design: This is a descriptive study that was based on a method- ological literature search; in order to achieve a significant amount of updated information, ten articles were used. Setting: Clinical research center. Results: The divergence between the logic of care (prevention and care) and the Social Security Agency (insurance) is reflected in daily conflicts and contradictions, which appear in the conduct of cases and may compromise treatment, secondary prevention and voca- tional rehabilitation. Conclusions: We need to incorporate Social Security (insurance) in its concept of excellence to his character, in fact, the public and their important role in the implementation of social security, insti- tutional transparency, enabling broad participation of society in decisions regarding their courses. Poster 4 An Interactive Format for Improving Medical Student Exposure to Physical Medicine & Rehabilitation. Kimberly Ross (University of Miami Miller School of Medicine, Coral Gables, FL, United States); Seema R. Khurana, DO; Gabriel H. Sunn, MD. S189 PM&R Vol. 4, Iss. 10S, 2012
Transcript of Poster 3 Rehabilitation Work
Participants: Adrian Cristian, MD, MHCM; Marc Ross, MD;Vishal Rekhala, DO; Laurentiu Dinescu, MD; Fred Aziz, MD; EthanEgan, MD; Travis VonTobel, MD.Interventions: A multidisciplinary approach was used to iden-tify and define: a) the steps involved in the completion ofconsults on a consult service, b) barriers in the process, c)interventions that remove or minimize the barriers. The majorbarriers identified included: a) lack of prioritization of consults,b) Lack of coordinated communication between resident physi-cians, rehab office administrators and attending physicians, c)reduced opportunities for teaching of residents on consult ser-vice, and d) inaccurate workload data collected for follow-upvisits on the consult service. A time study on 109 consults wascarried out to determine the number of minutes needed tocomplete a consult by a resident. Data was also collected on thenumber of consults requests received by day of the week. Onceidentified, the interventions were implemented in a pilot pro-gram. Data collected revealed the following: a) majority of theconsults occurred early in the week and b) time to completeconsults ranged from 35-52 minutes. The interventions identi-fied for the pilot program were: a) addition of another resident,b) an “on-call” consult attending physician schedule, c) develop-ing a mechanism to collect data that was more reflective of allworkload completed by residents on consult service, d) develop-ing and implementing a mechanism to prioritize consults, e)establishing a “cap” on the total number of consults to becompleted per day by residents, and f) strategies to improvecommunication between all involved parties.Main Outcome Measures: Resident satisfaction survey.Results: Residents have expressed improvement in the overallquality of the consult service rotation in terms of improved super-vision, teaching and workload.Conclusions: Resident experience on a PMR consultation servicecan be improved through a multidisciplinary approach and usingQI methodology.
Poster 2Impact of a Reproducible Complex PartnershipBetween Physiatry and Emergency Medicine onSpine Care.Andrew J. Haig, MD (Haig et al, Consulting, AnnArbor, MI, United States); Katrina Diaz, BS; Sierra Loar,MPA; David Share, MD; Bradley Uren, MD.
Disclosures: A. J. Haig, Ownership or partnership: Haig et al.,Consulting LLC; Non-remunerative positions of influence, TheInternational Rehabilitation Forum; The International Society forPhysical and Rehabilitation Medicine; Non-remunerative positionsof influence; The University of Michigan.Objective: Back pain is common and costly; often mismanagedin Emergency Departments (ED). To address this issue a complex,codified, yet reproducible process is needed. This project evaluatesthe impact of one such protocol, FastBack™, on emergency care ofback pain.Design: Prospective trial.Setting: University hospital, large and small community hospitals.Participants: 200 consecutive university hospital adult ED pa-tients with back pain before, at onset, and 6 months after Fast-Back™ consultation.Interventions: The FastBack™ protocol includes multipronged
ED staff education, patient intake forms, special PT protocols, andphysiatrist agreement to see ED patients within 48 hours. EDphysicians triaged patients to admission, simple discharge, physicaltherapy or physiatrist. The protocol was launched at the threehospitals. Data collection and storage were independent from theintervening consultant, and the final results will be verified by anindependent statistical group.Main Outcome Measures: Successful execution of the pro-gram, ‘Bounce backs’ to the ED within 1 month, advanced imaging,opiate prescription, therapy and physiatry referrals.Results: All 3 hospitals successfully launchedFastBack™. How-ever, the large community hospital was research non-compliant andthe small community hospital data is pending. At the universityhospital, emergency department ‘bounce backs’ who returnedwithin a month dropped from 10% to 2%. Opiate prescriptionsfrom 40% to-28%, diazepam from 19% to 12%, and MRI scans from11.5% to 8.5%, though there was an increase in CT scan use. PTreferrals went from 0 to 23, and PM&R referrals from 13-38.Conclusions: FastBack™ is executable across diverse settings. Atthe university hospital, all important metrics except CT scan usemoved towards improved quality of care. A complex, holistic, butcodified and reproducible consultation process results in decreasedreturns to emergency department and shift of care to better qualityfor persons with low back pain. Project funded through the Centerfor Healthcare Research & Transformation, and supported by BlueCross Blue Shield of Michigan and the University of Michigan.Performed independently by Haig et al., Consulting.
Poster 3Rehabilitation Work.Chennyfer P. Paim, PhD (University Nove de Julho, SãoPaulo, Brazil); Dayana Pinezzi, student.
Disclosures: C. P. Paim, No Disclosures.Objective: To contextualize the impact and difficulties faced inthe rehabilitation process of formal workers in Brazil. This is adescriptive study that was based on the methodological literature; inorder to achieve a significant amount of updated information, tenarticles were used.Design: This is a descriptive study that was based on a method-ological literature search; in order to achieve a significant amount ofupdated information, ten articles were used.Setting: Clinical research center.Results: The divergence between the logic of care (prevention andcare) and the Social Security Agency (insurance) is reflected in dailyconflicts and contradictions, which appear in the conduct of casesand may compromise treatment, secondary prevention and voca-tional rehabilitation.Conclusions: We need to incorporate Social Security (insurance)in its concept of excellence to his character, in fact, the public andtheir important role in the implementation of social security, insti-tutional transparency, enabling broad participation of society indecisions regarding their courses.
Poster 4An Interactive Format for Improving Medical StudentExposure to Physical Medicine & Rehabilitation.Kimberly Ross (University of Miami Miller School ofMedicine, Coral Gables, FL, United States); Seema R.Khurana, DO; Gabriel H. Sunn, MD.
S189PM&R Vol. 4, Iss. 10S, 2012
