The Impact of Introducing a Physical Medicine and Rehabilitation Trauma Consultation Service to an Academic Level 1 Trauma Center

Robinson, Lawrence R.; Tam, Alan; MacDonald, Shannon L; Hanada, Edwin; Berbrayer, David; Abdullahi, Abdikarim; Camilotti, Bruna; Tien, Homer

doi:10.1097/phm.0000000000001007

Cited by 11 publications

(8 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We chose to include the number of comorbidities over relative weight in our multivariable model because of its ease of clinical interpretation compared to a complex score such as relative weight, which also incorporates comorbid conditions into its calculation algorithm. This finding is consistent with previous reports that early PM&R consultation for patients with TBI and trauma is associated with decreased LOS 10,11 . Consultation within the first week may have the most effect on complication reduction and discharge from acute‐care.…”

Section: Discussionsupporting

confidence: 92%

“…In this study, most BIM consults were placed >48 hours from admission. Thus we divided early/late groups based on the median time between inpatient admission and time to BIM consultation, as was described in a recent study 11 . We stratified patients based on the median time between admission and initial BIM continuity consultation.…”

Section: Methodsmentioning

confidence: 99%

“…Another study comparing patients hospitalized with TBI to historical controls before a PM&R consultation service was developed found that severe trauma patients with earlier PM&R consultation (<8 days) had shorter LOS. Even after adjusting for injury severity score and Glasgow Coma Scale (GCS) score, early consultation was associated with an acute hospital LOS reduction of 11.8 days 11 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of an acute care brain injury medicine continuity consultation service on health care utilization and rehabilitation outcomes

Weppner

Linsenmeyer

Wagner

2021

PM&R

View full text Add to dashboard Cite

Introduction Although general physiatry acute‐care consultation services are commonplace and improve length of stay (LOS), the benefits of a subspecialty physiatric continuity consultation service targeting patients with severe brain injury have not been reported. Objectives Our primary objective was to characterize patient care recommendations from a Brain Injury Medicine (BIM) Continuity Consult Service, and to investigate the effects on acute‐care LOS relative to brain injury patients receiving General Physical Medicine & Rehabilitation (PM&R) Consult Services. Our secondary objectives were to examine inpatient rehabilitation (IPR) health care utilization metrics and costs between groups and evaluate clinical improvements during IPR and discharge disposition. Design Retrospective cohort comparison study. Setting Academic medical center with level 1 trauma center. Participants Adults with severe brain injury admitted to a single‐site acute‐care facility and subsequently admitted to a single inpatient brain injury rehabilitation unit over the same time period. Physiatric Care Models BIM Continuity Consult Service versus General PM&R Consult Service. Main Outcome Measures Acute‐care LOS; unplanned discharges to acute‐care. Results Despite no major demographic or clinical group differences, the BIM Consult Service had more patient comorbidities than General PM&R Consult Service (17.5±5.3 versus 16±5.1;P = .04). BIM Consult Service patients spent fewer days in acute care (30±11.8 versus 36±22.8; P = .008), and early BIM consult (≤7 days after admission) was associated with shorter acute‐care LOS (P < .002). IPR LOS was similar between groups when considering unplanned transfers. Unplanned transfers among General PM&R Consult Service patients occurred twice as frequently as in BIM Consult Service patients; average readmission costs were $2778 per patient on the BIM Consult Service and $6702 per patient on the General PM&R Consult Service. More BIM Consult Service (85.7%) than General PM&R Consult Service (27.3%) patients emerged from disorders of consciousness during IPR (P = .02). Conclusions BIM Continuity Consultation Services were associated with shorter acute‐care LOS, fewer unplanned acute‐care transfers, and an increased likelihood of emerging from a minimally conscious state during IPR.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of an acute care brain injury medicine continuity consultation service on health care utilization and rehabilitation outcomes

Weppner

Linsenmeyer

Wagner

2021

PM&R

View full text Add to dashboard Cite

show abstract

“…The patient was also consistently bearing weight on the operated limb as soon as the motor block wore off, 12 hours after the surgery. Human literature associates early intervention in this manner with improved postoperative outcomes32 33 and veterinary literature is so far pointing in the same direction 34 35…”

Section: Discussionmentioning

confidence: 99%

Opioid‐free anaesthesia (OFA) in a springer spaniel sustaining a lateral humeral condylar fracture undergoing surgical repair

Geddes

Stathopoulou

Viscasillas

et al. 2019

Vet Record Case Reports

View full text Add to dashboard Cite

A two-year, three-month-old male entire springer spaniel presented for right thoracic limb lameness. Radiographs of both elbows revealed a right lateral humeral condylar fracture. Local anaesthesia using bupivacaine was supplied to the site using a continuous stay peri-neural catheter at the brachial plexus. The fracture was stabilised using a lag screw and locking compression plate (LCP) plate. No response to surgical stimulation was noted on the patient’s vital parameters during anaesthesia, systemic analgesia was deemed not to be required. Bupivacaine was administered through the brachial plexus catheter every seven hours postoperatively. Pain scores were noted to be low, hence no systemic opioids were provided. The use of a continuous peripheral nerve block allowed for cold packs and passive range of motion exercises the same day of surgery. It also allowed for a lack of requirement of systemic opioids for the duration of hospitalisation.

show abstract

“…Early rehabilitation input is associated with reduced length of stay and other benefits and later the same expert can, for example, support return to work. 27…”

Section: The Underlying Problemsmentioning

confidence: 99%

Management of traumatic brain injury: practical development of a recent proposal

2022

View full text Add to dashboard Cite

A recent article identified weaknesses in the management of patients with traumatic brain injury (TBI). The authors suggested some reasons but overlooked two of the reasons for the low quality of services: a lack of resources and a systemic failure to organise rehabilitation services. They suggested early involvement of a condition-specific service with a new 'neuroscience clinician' and additional neuro-navigators, but the evidence shows this approach does not work. Their proposal failed to acknowledge the neuroscience skills of existing rehabilitation medicine consultants and teams, and ignored the many non-TBI problems patients will have and the consequent need for expert rehabilitation input. We revise and develop their proposal, suggesting an alternative way to improve services. Rehabilitation teams should work in parallel with acute services and remain responsible for the rehabilitation of patients as they move through different settings. This suggested development of rehabilitation mirrors the development followed by geriatric medicine from 40 years ago.

show abstract

The Impact of Introducing a Physical Medicine and Rehabilitation Trauma Consultation Service to an Academic Level 1 Trauma Center

Abstract: An acute care PM&R consultation <8 days after admission is associated with a shorter acute care LOS, fewer complications and less use of benzodiazepines and antipsychotics.

Cited by 11 publications

References 8 publications

Effects of an acute care brain injury medicine continuity consultation service on health care utilization and rehabilitation outcomes

Effects of an acute care brain injury medicine continuity consultation service on health care utilization and rehabilitation outcomes

Opioid‐free anaesthesia (OFA) in a springer spaniel sustaining a lateral humeral condylar fracture undergoing surgical repair

Management of traumatic brain injury: practical development of a recent proposal

Contact Info

Product

Resources

About