Disclosures: Megan E. Wright, MSPAS, PA-C: No financial relationships or conflicts of interest

Case Diagnosis: Application of change management principles to develop a physiatry service line.

Case Description or Program Description: Within the flagship academic medical center of a large healthcare system, a new inpatient physiatry consultation service was established utilizing principles of change management. Despite a growing body of evidence to support the role of physiatry in the acute care setting, this site had historically lacked physiatry infrastructure.

Setting: Academic, tertiary care hospital

Assessment/Results: The physiatry consultation service was initially set up as a pilot with 0.2 FTE. The following principles of change management were applied to program development: (i) A “burning platform” was established focused on improving patient throughput for functionally impaired patients in the acute care hospital, (ii) Input from multidisciplinary stakeholders was used to implement novel clinical pathways to overcome common bottlenecks in access to rehabilitation services, (iii) Successes were shared with hospital and health system leadership, leading to further expansion of this service.

Discussion (relevance): Within a three-year timeframe, several novel clinical pathways were implemented to optimize throughput for patients with functional deficits. Examples are: (i) Transition to post-acute rehabilitation for patients with post-stroke dysphagia and nasogastric tube, (ii) Transfer of patients in the “rehab gray zone” (patients with medical needs, not needing tertiary neurological care and not yet ready for inpatient rehabilitation) to a med-surg unit with daily rehabilitation therapy. Favorable results from implementation of these pathways convinced senior leadership to provide additional support to expand the physiatry consult service.

Conclusions: Our experience supports the role of the physiatrist as “change agent” in the acute hospital setting through application of transferable skills, including interdisciplinary team leadership, patient-centered goal setting, and complex problem solving based on the biopsychosocial model of medicine. Developing and implementing innovative care pathways facilitated improvements in patient throughput while removing barriers to rehabilitation, helping to build the business case for expansion of a physiatry consultation service.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/physiatry-as-change-agent-applying-change-management-principles-to-physiatry-service-line-development-in-the-acute-hospital-setting/