Consistency of post-acute care discharge recommendations among acute care physical therapists: a national vignette survey study

BACKGROUND: Physical therapists (PTs) contribute to discharge planning by recommending post-acute setting and rehabilitation needs. Evidence suggests better outcomes when PTs recommendations are followed, yet preliminary work suggests acute care PTs may be inconsistent when making discharge recommendations. PURPOSE: To quantify consistency of acute care PT discharge recommendations using standardized vignettes and evaluate whether degree level, years of experience, and experience in settings besides acute care influence therapist consistency. METHODS: Acute care PTs completed an electronic survey with ten clinical vignettes and selected an optimal discharge recommendation. Agreement was assessed with Fleiss' Kappa (95% CI); subgroup Kappa values were compared with two-tailed Z-tests. RESULTS: > .35). CONCLUSIONS: Discharge recommendations among acute care PTs showed low agreement nationally, particularly across adjacent post-acute options, and variability was not explained by training or experience. Results support strategies to improve calibration and shared understanding of post-acute settings to better match patients to services and reduce potentially avoidable costs.