A Qualitative Study of Clinical Decision Making in Recommending Discharge Placement From the Acute Care Setting
Open Access
- 1 March 2003
- journal article
- research article
- Published by Oxford University Press (OUP) in PTJ: Physical Therapy & Rehabilitation Journal
- Vol. 83 (3), 224-236
- https://doi.org/10.1093/ptj/83.3.224
Abstract
Background and Purpose. One of the roles of rehabilitation professionals in the acute care setting is making recommendations for patients' discharge placement. The purpose of this investigation was to explore the decision-making process of physical therapists and occupational therapists when recommending discharge destination for patients following acute care hospitalization. Subjects. Participants were 7 physical therapists and 2 occupational therapists in an acute care rotation at a large academic medical center. Methods. A grounded-theory strategy was used. Three interviews were conducted and guided by questions about participants' approaches to discharge decision making. Information from the interview transcripts was used to define constructs. A model was generated to explain the relationships among the constructs. Results. Decision making regarding discharge recommendations was guided by 4 constructs: patients' functioning and disability, patients' wants and needs, patients' ability to participate in care, and patients' life context. Information was filtered through therapists' experiences and modified by the health care team's opinions and by health care regulations. Discussion and Conclusion. The decision making of the rehabilitation professionals studied in recommending discharge placements for their patients reflects consideration of patients as individuals and the environments in which they live. Information about patients is filtered through the experience of therapists and influenced by health care regulations and opinions of other health care professionals, the patients, and their associates. The findings might be used in teaching clinical decision making to clinicians and students as they learn to make discharge recommendations.This publication has 30 references indexed in Scilit:
- Selection for rehabilitation: acute care discharge patterns for stroke and orthopaedic patientsInternational Journal of Rehabilitation Research, 2001
- Documenting Productive Behaviors: Using the Functional Behavior Profile to Plan Discharge Following StrokeJournal of Gerontological Nursing, 2000
- POST-STROKE INPATIENT REHABILITATIONAmerican Journal of Physical Medicine & Rehabilitation, 1996
- Factors predictive of stroke outcome in a rehabilitation settingNeurology, 1996
- Predicting discharge destination of stroke patients using a mathematical model based on six items from the functional independence measureArchives of Physical Medicine and Rehabilitation, 1996
- The effect of third-party payers on the clinical decision making of physical therapistsSocial Science & Medicine (1982), 1995
- Factors Affecting the Outcomes of Hospitalized Dementia Patients: From Home to Hospital to DischargeThe Gerontologist, 1994
- Professional uncertainty and physician medical decision-making in a multiple treatment frameworkSocial Science & Medicine (1982), 1989
- Dealing With Medical Practice Variations: A Proposal for ActionHealth Affairs, 1984
- Sociologic Influences on Decision-Making by CliniciansAnnals of Internal Medicine, 1979