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A Qualitative Study of Clinical Decision Making in Recommending Discharge Placement From the Acute Care Setting

DU Jette, PT, DSc, is Professor and Program Director, Physical Therapy Program, Graduate School for Health Studies, Simmons College, Boston, Mass, and Research Coordinator, Department of Rehabilitation Services, Beth Israel Deaconess Medical Center, Boston, Mass.
L Grover, PT, is Team Leader, Inpatient Rehabilitation Services, Beth Israel Deaconess Medical Center
CP Keck, OTR/L, is Clinical Manager, Inpatient Rehabilitation Services, Beth Israel Deaconess Medical Center

Address all correspondence to Dr Jette at Simmons College, 300 The Fenway, Boston, MA 02115 (USA) (diane.jette{at}simmons.edu)

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.

Key Words: Decision making • Patient care planning • Patient discharge

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