105 - The Value of Physiatrist Involvement in Acute and Post-Acute Medical Care

Objectives: The objective of this study is to demonstrate the overall value that physiatrists add to the healthcare system by examining their contributions in both acute and post-acute stages of medical care. Specifically, the study aims to investigate the impact of physiatrist involvement on patient outcomes, cost effectiveness, and patient satisfaction in various medical conditions, including neurological and non-neurological issues.





Design: This study is a literature review that compiles and analyzes existing research and studies related to the role of physiatrists in healthcare. The review focuses on physiatrist involvement in acute care settings, financial benefits and length of stay (LOS) reduction, patient outcomes and satisfaction, and their contributions to both neurological and non-neurological conditions. It includes a synthesis of findings from multiple studies conducted in different healthcare settings and populations. Summary articles and original research with a focus on the role of physiatrist involvement on inpatient rehabilitation and patient outcomes were eligible for inclusion. Databases such as PubMed, Google Scholar, and the PM&R Journal were used to source articles.





Results: 1. Acute Setting Involvement: Physiatrists positively impact functional outcomes, ICU outcomes, length of stay (LOS) reduction, and patient satisfaction. Studies show that early physiatry consultations are associated with improved functional scores and shorter acute LOS.

2. Financial Benefits and LOS Reduction: Early involvement of physiatrists in acute patients leads to significant financial benefits and reduced LOS. Initiatives involving physiatry services have resulted in substantial cost savings, even with increased rehabilitation service costs.

3. Patient Outcomes and Satisfaction: Physiatrists' early involvement consistently correlates with improved patient outcomes, shorter LOS, and greater patient satisfaction. Studies show that physiatrist involvement in conditions like burn injuries, stroke, and trauma leads to better functional independence and home discharge rates.

4. Non-Neurological Conditions: Physiatrist involvement extends beyond neurological injuries to medical conditions such as hip fractures, LVAD recovery, and spine conditions. Studies demonstrate improved outcomes and reduced LOS when physiatrists are part of the care team.



Conclusions: Physiatrists contribute significantly to the healthcare system by positively impacting patient outcomes, reducing LOS, and providing cost-effective care. Their expertise in physical medicine and rehabilitation is valuable in both acute and post-acute stages of medical care, expanding beyond the scope of neurological and musculoskeletal debilitations. The study emphasizes the need to recognize and incorporate physiatrists into multidisciplinary care teams, and it calls for further research, including randomized controlled trials, to explore their potential in new clinical areas. Expanding the role of physiatrists can enhance patient care, improve functional outcomes, and increase healthcare value.





Scientific Paper Best Paper Award Abstract: Physiatrists are specialized physicians in physical medicine and rehabilitation (PM&R) who play a pivotal role in diagnosing, evaluating, and treating patients with physical disabilities, aiming to restore maximum physical, psychological, social, and vocational function through comprehensive rehabilitation. The purpose of this literature review is to explore the multifaceted contributions of physiatrists to the healthcare system, with a central focus on their involvement in both acute and post-acute stages of medical care.

In the acute setting, physiatrists coordinate rehabilitation efforts, manage medical complexities, and determine post-acute rehabilitation needs. Numerous studies underscore the positive impact of early physiatrist involvement on functional outcomes, ICU outcomes, reduced length of stay, and overall patient satisfaction. For example, studies have shown that early physiatry consultations for nonfatal brain injuries and stroke patients result in improved functional scores and shorter acute length of stay. Moreover, involving physiatrists in post-acute care has been associated with a significant reduction in emergency department visits within 30 days, highlighting their role in enhancing continuity of care.

Financial benefits and length of stay reduction are some of the key outcomes associated with early and dedicated physiatrist involvement. Initiatives at medical centers have demonstrated shorter length of stay for patients receiving physiatric consultation or direct management, leading to substantial cost savings. Studies estimate annual cost savings of up to several million dollars through the implementation of early rehabilitation programs in ICU settings. These findings emphasize the cost-effectiveness of physiatry services, despite the initial investment in rehabilitation.

Studies in various patient populations, including acute burn patients, stroke survivors, and trauma patients, highlight the importance of early interventions in enhancing functional independence, cognitive improvement, and home discharge likelihood. Physiatrist involvement consistently leads to improved patient outcomes and satisfaction. In stroke patients, comprehensive rehabilitation services are associated with greater recovery of physical and cognitive independence, improved home discharge rates, and improved long-term survival. The importance of early consultation for trauma patients is evident in reduced length of stay, fewer complications, and decreased medication usage.

Physiatrists' contributions extend beyond neurological injuries to encompass various medical conditions such as hip fractures, spine disorders, left ventricular assist device (LVAD) recovery, and nonurgent spine surgery consultations. Studies in LVAD recovery demonstrate the effectiveness of inpatient rehabilitation in reducing readmissions and improving functional outcomes. Physiatrists serving as primary physicians for elderly patients following hip fractures have been associated with higher functional independence and decreased length of stay.

Incorporating physiatry care early in a patient's acute care needs transcends cost savings, with an emphasis on improved patient outcomes and experiences. Patient-centered metrics, including functional outcomes, complication rates, and satisfaction, position physiatrists as critical team members in healthcare delivery. Their expertise in physical medicine and rehabilitation uniquely qualifies them to address the complex needs of patients, contributing to enhanced healthcare quality.

The value physiatrists provide to the healthcare system is demonstrated through their efficacy in enhancing patient outcomes, reducing length of stay, and providing cost-effective care. Their expertise in both acute and post-acute care settings demonstrates their ability to improve patient functional recovery, decrease hospital expenses, and enhance the overall value of healthcare. Continued research, collaboration, and integration of physiatrists into multidisciplinary care teams are essential to further explore their potential in diverse medical settings. Additional studies, including randomized controlled trials, are needed to validate the value of physiatry in terms of cost effectiveness, improved functional outcomes, and better patient quality of life. Expanding the role of physiatrists and educating patients on the benefit of incorporating rehabilitation early into their care can lead to improved contributions to patient care, outcomes, and healthcare value.