Lower AM-PAC 6-Clicks Basic Mobility Score Predicts Discharge to a Postacute Care Facility Among Patients in Cardiac Intensive Care Units

Abstract

Objective The objective of this study was to determine the ability of the AM-PAC“6-Clicks” Basic Mobility Short Form to predict patient discharge destination (home vs postacute care facility) from the cardiac intensive care unit (ICU), including patients from the cardiothoracic surgical ICU (CTS-ICU) and coronary care unit (CCU). Methods This retrospective cohort study utilized electronic medical records of patients in cardiac ICU (n = 359) in an academic teaching hospital in the southeastern region of United States from September 1, 2017, through August 31, 2018. Results The median interquartile range (IQR) age of the sample was 68 (75–60), 55% were men, median IQR “6-Clicks” score was 16 (20–12) at physical therapist evaluation, and 79% of the patients were discharged to home. Higher score on “6-Clicks” indicates improved function. A prediction model was constructed based on a machine learning approach using a classification tree. The classification tree was constructed and evaluated by dividing the sample into a train-test split using the Leave-One-Out cross-validation approach. The classification tree split the data into 4 distinct groups along with their predicted outcomes. Patients with a “6-Clicks” score > 15.5 and a “6-Clicks” score between 11.5 and 15.5 with primary insurance other than Medicare were discharged to home. Patients with a “6-Clicks” score between 11.5 and 15.5 with Medicare insurance and those with 6-Clicks score ≤ 11.5 were discharged to a postacute care facility. Conclusions Patients with lower “6-Clicks” scores were more likely to be discharged to a postacute care facility. Patients without Medicare insurance had to be significantly lower functioning indicated by lower “6-Clicks” scores for postacute care facility placement than those with Medicare insurance. Impact The ability of “6-Clicks” along with primary insurance to determine discharge destination allows for early discharge planning from cardiac ICUs.

Using Outcome Measures to Transition Ambulation From Physical Therapy to Nursing for Patients With Mechanical Circulatory Support

“…The outcome of this study recommends an AM-PAC score of more than 19, which is similar to Fernandez's guideline for discharge from skilled physical therapy services. The Whitlock et al 27 prediction model indicates that patients in a cardiac ICU with lower AM-PAC scores had a higher chance of being discharged to a PAC facility. This recommendation supports our findings to keep patients with lower AM-PAC scores on the physical therapy caseload, rather than transitioning them to ambulate with nursing staff.…”

“…There is limited evidence about the use of a cutoff score when transitioning ambulation from physical therapy to nursing service. Cutoff scores from certain outcome measures have been used to suggest patient discharge location [26][27][28] and risk of frailty, rehospitalization, mortality, and morbidity, [29][30][31] but never to support the transition of mobility responsibility while patients are still admitted in an acute care setting. The primary aim of this study is to explore the feasibility of using cutoff scores for AM-PAC, Perme, and gait speed to determine when it is most appropriate to transition ambulation from physical therapy service to nursing service.…”

Therapists Predict Discharge Destination More Accurately Than the AM-PAC “6 Clicks” at Evaluation and Discharge for Patients With Isolated Coronary Artery Bypass Graft

“…Conversely, patients who undergo robotic CABG or valve replacement via thoracotomy or other minimally invasive approach would likely score higher on their AM-PAC “6 Clicks” assessments, as their postoperative limitations are minimal compared with those of open chest surgery. Others have found use of this tool in the cardiac intensive care unit setting, but calculated a different score cut-off to make discharge recommendations from other studies 10,11. Also of note is that this quality assessment was planned prior to the coronavirus disease-2019 (COVID-19) pandemic; however, data collection occurred at its onset.…”

“…Others have found use of this tool in the cardiac intensive care unit setting, but calculated a different score cut-off to make discharge recommendations from other studies. 10,11 Also of note is that this quality assessment was planned prior to the disease-2019 (COVID-19) pandemic; however, data collection occurred at its onset. Patients received the same standard of care in regard to surgery, recovery, OT/PT evaluations, and discharge processes as before the pandemic; however, testing for COVID-19, visitor restrictions and use of personal protective equipment became hospital requirements during this time frame.…”

“Beyond waking and walking. Intensive rehabilitation in patients requiring extended durations of advanced mechanical circulatory support: A case series”

“…"6-Clicks'' was developed, validated, and has the ability to predict hospital discharge destination when performed on physical therapist evaluation while patient is admitted within the CVICU. 16 The "6-Clicks" assesses six basic mobility tasks scored between a 1-requiring total assist to perform or is unable to perform safely, and 4-able to perform independently, for a total of 24 points. The basic mobility tasks include rolling in bed, supine to sit transfers, sit to stand transfers, bed to chair transfers, short-distance gait, and stair climbing.…”