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Quality Improvement (Original Research)

A Quality Improvement Project to Promote Early Physiatry Consultation to Reduce Length of Stay in Traumatic Brain Injury Patients

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Disclosure(s):
Raymond Mathews, MD: No financial relationships to disclose
Norberto Escobales, MD: No financial relationships to disclose
Tommie Russell Berry, MD, Jr.: No financial relationships to disclose
Background and/or Objectives: Moderate and severe traumatic brain injury (TBI) patients often experience prolonged hospital stays due to delayed involvement of rehabilitation services. Early physiatry consultation ( < 48 hours after TBI admission or < 8 days for any trauma) can improve care coordination, reduce length of stay (LOS), and enhance functional outcomes . However, delayed consultations remain common, contributing to fragmented care and extended hospitalizations. This quality improvement project aimed to reduce LOS for TBI patients at a single academic Level 1 trauma center by decreasing time to physiatry consultation.

Design: Using the Plan-Do-Study-Act (PDSA) methodology, baseline data on LOS and time to physiatry consultation were collected. Existing guidelines, policies, and order sets were reviewed, and an early consultation protocol was developed. The protocol was implemented through updates to admission order sets, hospital-wide announcements, and staff education. Ongoing monitoring with monthly reviews allows for iterative refinements.

Setting : An academic Level 1 trauma center in Philadelphia.

Participants : Adult patients hospitalized with a non-fatal TBI.

Interventions: Interventions included the addition of physiatry consultation to admission order sets for TBI patients, establishment of clear communication pathways between admitting services and the physiatry team, and standardized education for hospital staff on the benefits of early physiatry involvement.

Main Outcome Measures: Primary outcomes include a reduction in the average LOS for TBI patients and improvement in discharge disposition, aiming for increased discharges to rehabilitation facilities or home rather than long-term acute care or skilled nursing facilities.

Results: Ongoing data collection is assessing LOS and discharge dispositions to evaluate the program’s impact on patient care. Outliers are being reviewed to identify potential barriers and opportunities for further improvement.

Conclusions: This project demonstrates the integration of evidence-based rehabilitation practices into existing workflows at an academic Level 1 trauma center through the PDSA methodology. Early physiatry consultation has the potential to optimize care coordination and reduce LOS for TBI patients.