By: Dr. Saturn B. Dagwase, DPT, CWS, CLT-LANA, FACCWS

Case Study #1.

Case Study: The Role of Physical Therapy Consultation in Hospital Discharge Decisions

A 75-year-old male patient, Mr. J., was admitted to an acute care hospital following a left total hip replacement due to severe osteoarthritis. Despite successful surgery and stable vital signs, his post-operative recovery raised concerns about his ability to safely transition home. The hospitalist physician leading Mr. J.’s care team was hesitant to approve discharge without ensuring his physical and functional readiness.

Mr. J. presented with several factors that complicated discharge planning. Post-operative pain and weakness significantly hindered his ability to walk and perform basic activities of daily living (ADLs). Additionally, a history of previous falls heightened concerns about his safety in an unmonitored home environment. His home setup also posed challenges, including stairs and the absence of safety modifications such as grab bars.

Recognizing the complexities of Mr. J.’s case, the hospitalist ordered a physical therapy (PT) consultation to evaluate his functional status and develop a plan for a safe discharge. The PT team conducted a comprehensive assessment, which included measuring gait speed, balance, and endurance using tools such as the Timed Up and Go (TUG) test. They also evaluated his lower extremity strength to determine his ability to perform weight-bearing tasks and observed his capacity to complete essential ADLs like transferring from bed to chair and toileting.

Based on their findings, the PT team provided several targeted interventions and recommendations. They designed a tailored therapeutic exercise program aimed at strengthening Mr. J.’s hip and core muscles to improve mobility and reduce pain. They trained him in the safe use of a walker for ambulation and suggested specific home modifications, such as installing grab bars and removing tripping hazards. Additionally, they recommended short-term admission to an inpatient rehabilitation facility for intensive therapy and fall prevention training.

The hospitalist physician incorporated the PT team’s input into the discharge plan. Consequently, Mr. J. was transferred to a rehabilitation facility, where he received structured therapy sessions. After two weeks, he demonstrated significant improvement in mobility and functional independence, allowing for a safer discharge to his home.

This case highlights the indispensable role of PT consultations in hospital discharge planning. Without the PT team’s evaluation, Mr. J. might have been prematurely discharged, increasing his risk for falls, readmissions, and delayed recovery. PTs provide critical insights into a patient’s readiness for discharge by assessing functional abilities and addressing barriers to independence. Their expertise ensures that discharge decisions prioritize patient safety and long-term outcomes.

Hospitalist physicians and physical therapists must collaborate to optimize patient care in acute settings. This case underscores the importance of involving PTs in complex discharge decisions, particularly for patients with mobility impairments or high fall risks. By working together, healthcare teams can enhance patient outcomes and reduce the likelihood of complications or readmissions.

Case #2. 

Case Study: The Role of Physical Therapy in the Emergency Room

A 68-year-old female patient, Mrs. K., presented to the emergency room (ER) following a fall at home. She reported feeling dizzy before the fall but denied any loss of consciousness or significant pain. On examination, she was found to have no apparent injuries, and imaging studies ruled out fractures or internal trauma. A cardiac workup, including an electrocardiogram and lab tests, yielded promising results, and she was deemed hemodynamically stable.

Although Mrs. K. did not sustain any physical injuries, her complaint of dizziness raised concerns about underlying causes. The ER physician sought to determine whether her dizziness was related to a transient cardiac event, a neurological issue, or another condition. Recognizing the potential for functional impairments and the risk of future falls, the ER team consulted a physical therapist to evaluate her balance and vestibular function.

The PT conducted a thorough assessment, focusing on Mrs. K.’s balance, gait, and vestibular system. Key findings included positive results for benign paroxysmal positional vertigo (BPPV) during the Dix-Hallpike maneuver, moderate instability during static and dynamic balance tests such as the Romberg test and functional reach test, and mild unsteadiness during gait assessment, especially with head movements. These findings were consistent with vestibular dysfunction.

Based on the assessment, the PT initiated treatment to address Mrs. K.’s vestibular dysfunction. The interventions included performing the Epley maneuver to treat BPPV, which resulted in immediate symptom relief. The PT also introduced simple balance training exercises, such as tandem stance and weight shifts, to improve her stability. Additionally, Mrs. K. was educated about BPPV, including its triggers and strategies to avoid exacerbating symptoms, such as safe positioning and movement techniques.

Following the PT’s intervention, Mrs. K. reported significant improvement in her dizziness and felt more confident in her ability to move without fear of falling. The ER physician, in collaboration with the PT, determined that she was safe for discharge. Mrs. K. was provided with a home exercise program to continue balance training and referred to outpatient physical therapy for follow-up care.

This case demonstrates the critical role of physical therapists in the emergency room setting. By identifying and treating vestibular dysfunction, the PT not only addressed the immediate cause of Mrs. K.’s dizziness but also reduced her risk of future falls and associated complications. Without PT involvement, her condition might have been misattributed to other causes, potentially leading to unnecessary admissions or delayed recovery.

Physical therapists bring valuable expertise to the ER, particularly in assessing and managing conditions such as dizziness, balance impairments, and functional limitations. This case highlights the importance of interdisciplinary collaboration in acute care settings, ensuring timely and effective interventions that enhance patient outcomes and support safe discharges.

Case #3. 

Case Study: The Role of Physical Therapy in the PACU for Same-Day Discharge of Total Hip and Knee Replacement Patients

A 62-year-old male patient, Mr. L., underwent a total knee replacement (TKR) in the morning and was transferred to the post-anesthesia care unit (PACU) for recovery. The surgical team had planned for a same-day discharge, contingent on the patient meeting specific functional and safety criteria. Recognizing the critical role of mobility in determining discharge readiness, the PACU team consulted a physical therapist to evaluate Mr. L. and provide necessary interventions.

Upon arrival in the PACU, Mr. L. was alert, hemodynamically stable, and reported manageable pain levels with intravenous and oral analgesics. The physical therapist’s assessment focused on mobility, pain management, and patient education. Initial tests evaluated his ability to perform bed mobility, transfer from bed to chair, and initiate ambulation with an assistive device. Despite mild initial stiffness, Mr. L. successfully demonstrated independent bed mobility and transfers. With the guidance of the PT, he ambulated 20 feet using a walker, meeting the distance requirement for discharge.

The physical therapist also provided strategies for managing post-operative pain and swelling, including education on the importance of ice application, elevation, and early movement. Additionally, the PT taught Mr. L. critical safety measures to prevent falls and injury during recovery, emphasizing proper use of the walker, safe navigation of home environments, and the avoidance of excessive strain on the surgical knee. The therapist provided a home exercise program tailored to his needs, focusing on range of motion, quadriceps strengthening, and gentle functional movements to support early recovery.

By collaborating with the PACU team, the physical therapist ensured that Mr. L. met all mobility and functional criteria for same-day discharge. He left the hospital confident in his ability to safely manage activities of daily living and follow his rehabilitation plan. Follow-up physical therapy was arranged for ongoing care.

This case highlights the integral role of physical therapy in the PACU for patients undergoing total joint replacements with same-day discharge plans. PTs not only assess patients’ functional readiness but also provide critical education and interventions that empower patients to transition safely to their home environment. Their expertise is essential in facilitating safe, efficient discharges while promoting positive outcomes and patient satisfaction. This case underscores the importance of early PT involvement in perioperative care to optimize recovery and reduce hospital stays.

Case #4.

Case Study: The Essential Role of Physical Therapy in Reducing Hospital Length of Stay

A 70-year-old female patient, Mrs. M., was admitted to the hospital following a diagnosis of pneumonia with secondary complications including generalized weakness and reduced mobility. After stabilization of her respiratory status, the primary medical team faced challenges related to Mrs. M.’s physical deconditioning. Prolonged bed rest had led to a significant decline in her ability to perform activities of daily living (ADLs), raising concerns about her ability to safely discharge home.

Recognizing the critical need for mobility-focused intervention, the attending physician consulted the physical therapy (PT) team. The PT assessment revealed marked muscle weakness, impaired balance, and a reduced capacity for ambulation. These findings were consistent with hospital-acquired deconditioning, a common complication in hospitalized patients who remain immobile for extended periods. Without PT involvement, Mrs. M. faced an increased risk of further decline, prolonged hospitalization, and potential readmission (Falvey et al., 2015).

The physical therapist implemented an individualized mobility program aimed at early and progressive mobilization. Interventions included bedside exercises to rebuild strength, balance training to reduce fall risk, and gradual ambulation with assistive devices. Over the course of five days, Mrs. M. progressed from requiring assistance for bed-to-chair transfers to independently walking 50 feet with a walker. The PT also educated her on energy conservation techniques and safe movement strategies to support her recovery.

As a result of PT involvement, Mrs. M.’s overall functional status improved significantly, enabling her to safely discharge home with a clear follow-up plan for outpatient therapy. Her timely mobilization not only shortened her length of stay by an estimated two days but also reduced the likelihood of complications such as pressure injuries, deep vein thrombosis, and additional loss of muscle mass. Without PT’s expertise, Mrs. M. might have experienced a cascade of complications that could have necessitated a longer hospital stay and more intensive post-discharge care (Hoyer et al., 2018).

This case underscores the indispensable role of PTs as mobility experts in the hospital setting. They address the physical and functional barriers that often prolong hospital stays and hinder recovery. Evidence shows that early mobilization and PT-led interventions lead to better patient outcomes, including reduced length of stay, fewer complications, and improved quality of life (Hoyer et al., 2018). The cost savings associated with shorter hospital stays further highlight PTs’ value as essential, not optional, members of the healthcare team.

Discussion

Hospital administrators must recognize the substantial financial impact of shortened lengths of stay achieved through PT services. Reduced hospitalization days translate to lower operational costs, increased patient turnover, and optimized resource utilization, which are critical metrics for hospital efficiency and profitability. Moreover, PT interventions can help prevent costly complications such as falls, pressure injuries, and hospital-acquired infections, all of which contribute to penalties under value-based purchasing models (Stevens-Lapsley et al., 2021).

From a clinical perspective, PTs ensure patients achieve better functional outcomes and lower readmission rates, aligning with healthcare quality goals. Administrators should understand that PT services are not merely an added expense but a cost-saving strategy that also enhances patient satisfaction. By reducing the length of stay and preventing complications, PTs provide a dual benefit—improved clinical outcomes and significant financial returns for the institution.

Physical therapists should be viewed not just as providers of rehabilitation services but as integral contributors to acute care management. Hospitals aiming for excellence in outcomes and efficiency must prioritize the integration of PT into standard care pathways. This ensures that PTs’ clinical expertise and financial impact are fully utilized, ultimately driving better patient outcomes and stronger financial performance in acute care settings.

The role of physical therapists (PTs) in acute care hospital settings has evolved significantly in recent years. As healthcare systems worldwide strive for improved patient outcomes and cost-efficiency, PTs are increasingly recognized as integral members of interdisciplinary teams. Their roles extend beyond traditional rehabilitation services, encompassing acute care management, early mobility programs, discharge planning, and preventive interventions.

Expanding Scope of Practice

Physical therapists in acute care settings are no longer confined to post-surgical rehabilitation. Their expertise is now employed in managing a variety of conditions, including cardiopulmonary, neurological, and critical care cases. For instance, PTs play a critical role in early mobility programs for patients in intensive care units (ICUs), aiming to reduce the risk of complications such as deep vein thrombosis (DVT), pressure injuries, and muscle atrophy (Hodgson et al., 2018). By implementing evidence-based interventions, PTs contribute to shorter hospital stays and improved functional outcomes.

Early Mobility Programs

Early mobility programs have become a cornerstone of PT practice in acute care. These programs involve initiating movement and physical activity as soon as it is clinically safe, even for critically ill patients. Research indicates that early mobility reduces the duration of mechanical ventilation, lowers ICU length of stay, and enhances long-term functional outcomes (Schweickert & Hall, 2009). PTs assess the patient’s readiness for mobility, tailor interventions to individual needs, and collaborate with the medical team to ensure patient safety.

Discharge Planning

Physical therapists also contribute significantly to discharge planning. They assess patients’ functional status and determine their need for continued care, such as outpatient therapy, home health services, or admission to a rehabilitation facility. This process involves evaluating patients’ mobility, strength, and ability to perform activities of daily living (ADLs), ensuring a safe transition from the hospital to the next level of care (Ohtake et al., 2018).

Specialized Care: Wound Care, Lymphedema, and Vestibular Management

Physical therapists in acute care settings are increasingly involved in specialized areas such as wound care, lymphedema management, and vestibular assessment and treatment. PTs utilize advanced techniques for wound care, including debridement, dressing selection, and patient education to promote optimal healing. In managing lymphedema, PTs apply manual lymphatic drainage, compression therapy, and therapeutic exercises to reduce swelling and improve limb function (Finnane et al., 2015). Additionally, PTs assess and treat vestibular disorders, addressing issues such as dizziness, vertigo, and balance impairments. Early intervention in these areas not only enhances recovery but also prevents complications that can extend hospital stays.

Addressing Preventive Care

Preventive care is another emerging area where PTs are making a difference. In acute care settings, PTs educate patients and caregivers on strategies to prevent complications such as falls, pressure ulcers, and hospital readmissions. For example, tailored exercise programs and fall prevention strategies can significantly reduce the risk of recurrent falls among older adults (Montero-Odasso et al., 2021).

Collaboration and Advocacy

The growing roles of PTs in acute care also underscore the importance of interdisciplinary collaboration. PTs work closely with physicians, nurses, occupational therapists, and other healthcare professionals to develop comprehensive care plans. Additionally, PTs advocate for patient-centered care, emphasizing the importance of physical activity and functional independence in overall health.

Challenges and Opportunities

Despite their expanding roles, PTs in acute care face several challenges, including high patient acuity, time constraints, and administrative demands. However, these challenges present opportunities for innovation and professional growth. By adopting technology such as EMR and electronic devices, PTs can enhance their assessment and intervention capabilities. Moreover, ongoing education and specialization in areas such as critical care, wound management, ICU, and vestibular rehab can further equip PTs to meet the demands of acute care settings.

Conclusion

The increasing roles of physical therapists in acute care hospital settings highlight their critical contributions to patient care. By addressing acute care needs, preventing complications, and facilitating safe discharges, PTs enhance patient outcomes and contribute to the efficiency of healthcare systems. As the scope of practice continues to expand, PTs must embrace opportunities for growth, collaboration, and advocacy, ensuring their place at the forefront of acute care delivery.

References

Falvey, J. R., Mangione, K. K., & Stevens-Lapsley, J. E. (2015). Rethinking hospital-associated deconditioning: Proposed paradigm shift. Physical Therapy, 95(9), 1307-1315. https://doi.org/10.2522/ptj.20140511

Hoyer, E. H., Friedman, M., Lavezza, A., Hoyer, M., Wagner-Kosmakos, K., Lewis-Cherry, R., & Skolasky, R. L. (2018). Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project. Journal of Hospital Medicine, 11(5), 341-347. https://doi.org/10.12788/jhm.2522

Stevens-Lapsley, J. E., Loyd, B. J., & Falvey, J. R. (2021). The role of physical therapists in reducing hospital readmissions: Optimizing outcomes and cost-efficiency. Journal of Geriatric Physical Therapy, 44(2), 89-95.  https://doi.org/10.1519/JPT.0000000000000284

Finnane, A., Hayes, S. C., & Janda, M. (2015). Clinical guidelines for lymphedema treatment: A systematic review. BMC Cancer, 15, 23. https://doi.org/10.1186/s12885-015-1275-6

Hodgson, C. L., Capell, E., & Tipping, C. J. (2018). Early mobilization of patients in intensive care: Organization, communication, and safety factors that influence translation into clinical practice. Critical Care Clinics, 34(4), 493-500. https://doi.org/10.1016/j.ccc.2018.06.006

Montero-Odasso, M., van der Velde, N., Martin, F. C., Petrovic, M., Tan, M. P., Ryg, J., … & Lamb, S. E. (2021). World guidelines for falls prevention and management for older adults: A global initiative. Age and Ageing, 50(6), 1499-1507. https://doi.org/10.1093/ageing/afab076

Ohtake, P. J., Strasser, D. C., & Needham, D. M. (2018). Rehabilitation interventions for critically ill patients in the ICU: A scoping review. Physical Therapy, 98(4), 233-245. https://doi.org/10.1093/ptj/pzy017

Schweickert, W. D., & Hall, J. B. (2009). ICU-acquired weakness. Chest, 135(5), 1234-1240. https://doi.org/10.1378/chest.08-3094