Development of a Unique Screening Tool for Acute Care Occupational Therapy Services in Patients Following Total Joint Replacement Surgery

Abstract

<h3>Research Objectives</h3> Assess use of an evidence-based screening tool to standardize patient access to Occupational Therapy (OT) services post Total Joint Arthroplasty (TJA) - Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). <h3>Design</h3> Process Improvement Study comparing the historical, subjective screen and a new evidence-based screening tool for referral of OT services. Data collected over a two month period for individuals undergoing a TJA. First month, collected data on the previous OT screen. Second month, collected data utilizing new screen. <h3>Setting</h3> Lehigh Valley Health Network-Tilghman Hospital (LVH-TH). <h3>Participants</h3> 326 patients admitted LVH-TH following THA/TKA surgery, including bilateral knee replacements. Patients excluded were TJA-revisions and those transferred out of the hospital prior to arrival to the unit. <h3>Interventions</h3> First month, physical therapists used clinical judgement and second month, completed evidence-based screening tool determining if OT was indicated. Included criteria include: inpatient rehab recommendation, difficulty maintaining hip precautions and/or meeting 3/5 of categories (social support, age, fall risk, AM-PAC score and co-morbidities). <h3>Main Outcome Measures</h3> The primary outcome was to identify the percentage of patients post-TJA receiving OT services pre/post-implementation of the evidenced-based OT screen. Patients requiring OT services despite a negative screen were tracked in both conditions. <h3>Results</h3> The subjective OT screen found that 45.6% of patients required OT services. The evidence-based screening tool showed that 48.8% of patients required OT services. In both conditions, 0.06% of patients required OT services, despite a negative screen. <h3>Conclusions</h3> OT plays a crucial role in treatment of functional deficits that prevent patients from completing activities of daily living following their hospital stay. An evidence-based screening tool for OT services was created to allow for the efficient utilization of OT services in the acute care setting following TJA. Our results indicate that the implementation of an evidence-based screening tool did not appear to alter the level of care provided to TJA patients. Further studies can be completed on self-efficacy of patients who receive and don't receive OT services. <h3>Author(s) Disclosures</h3> None.