An Inter-Professional Education Encounter to Improve Discharge Planning Among Physical Therapy and Physician Assistant Students
Purpose/Hypothesis:
One-fifth of hospitalizations are confounded by post-hospital discharge adverse events. Most of these events are due to variation in hospital discharge procedures and lack of identifying key patient discharge needs. Collaborative peri-discharge interventions have shown to decrease hospital readmission rates and adverse events. Group clinical decision-making (CDM) related to discharge planning is imperative. Physician assistants (PAs) and physical therapists (PTs) are assuming a more critical role in patients’ hospital discharge planning. Simulation inter-professional education (SIM-IPE) is an emerging teaching technique in healthcare education and occurs when participants from two or moreprofessions are engaged in a simulated health care experience to achieve shared or linked objectives. The aim of this study is to determine if SIM-IPE involving PA and PT students will impact hospital discharge disposition decisions. We hypothesize that SIM-IPE will impact hospital discharge disposition decisions.
Number of Subjects:
Twenty-eight second-year doctor of physical therapy students
Eighty first-year physician assistant students
Materials and Methods:
All students participated in a minimum of one of four SIM encounters designed as high-risk problem-prone acute care experiences. Eight simulated patients (SPs)- two for each diagnosis- were trained by faculty PAs, PTs, and clinical simulation personnel. "Diagnoses" were chronic normal pressure hydrocephalus, pneumonia with COPD exacerbation, bacterial endocarditis, and stroke due non-compliance with anticoagulant medication. Comprehensive electronic medical records (EMRs) were prepared for each diagnosis. The EMRs included consents to treat, insurance information, admitting notes, consultant notes, laboratory values, radiology reports, nursing notes, flow charts, and medication orders and history of administration. Four simulation rooms were developed consistent physical environments. The SIM-IQ system was utilized to videotape all encounters, provide a repository for the EMRs, used as a platform for post-encounter data entry and analysis, and for posting of student reflections. Encounters began with an electronic medical record review (each record having disposition challenges) by the student PT and PA, followed by individual and separate consultations with the SP. Immediately after the individual PA and PT patient encounters, each student was required to individually and independently determine discharge disposition location and priorities for selecting that particular disposition location. Then, a 30 minute post-encounter interprofessional education meeting between the PA and PT student with the aim of jointly "developing a 10 minute grand round presentation for your clinical instructors" and "to determine an appropriate disposition recommendation" facilitated CDM. Immediately after the 30 minute encounter the PA and PT students were once again required - this time jointly- to determine discharge disposition location and priorities for selecting that disposition Encounters concluded with grand rounds presentations to the “clinical instructors”. Lastly, students were required to watch the videotape of their experience and write a reflection.
Results:
The most recommended disposition after the individual interventions but prior to the 30-minute post-professional encounter interprofessional education meeting was the same between the PA and PT students for all encounters. However there was greater variation amongst locations by PA students as compared with PT students.
Pre-encounter, when considering discharge priorities, PA students gave the highest priority to medical status and PT students to functional status. However, after SIM-IPE, PA students ranked functional status higher and PT students ranked medical status higher as compared with the pre SIM-IPE data.
Conclusions:
This SIM-IPE successfully facilitated learning about discharge disposition decisions - including location and priorities - among PA and PT students. Limitations of this study include variation in sample size between PA and PT students.
Clinical Relevance:
CDM, facilitated by discussion among multi-disciplinary team members, can impact priorities when making discharge disposition decisions, ultimately leading to decreased incidence of adverse events.