Interdisciplinary communication in inpatient rehabilitation facility: evidence of under-documentation of spatial neglect after stroke

Abstract

Purpose Spatial neglect commonly occurs after stroke and predicts poor rehabilitation outcomes. However, this disorder is under-recognized in clinical practices, which may result from the failure to document its presence. This study aimed to identify the predictors for documentation of spatial neglect in inpatient rehabilitation facilities. Method We performed a comprehensive chart review to investigate whether the presence of spatial neglect was documented in 74 neglect patients’ clinical notes recorded by physicians, nurses, or occupational therapists (OTs), or in team conference notes. Independent variables included neglect severity, length of stay, Functional Independence Measure at admission and discharge. Results Of the 74 neglect patients, 75.7% were documented by OTs, 63.5% by physicians, and 17.6% by nurses. Although 93.2% of neglect patients were recognized by at least one clinician group, only 31.1% were discussed in multidisciplinary team conferences. Neglect patients who were documented by physicians were more likely to be documented in team conferences. While no factors predicted whether a neglect patient would be documented by nurses or OTs, we found significant predictors for neglect documentation in physician and team conference notes. The odds of being documented by physicians were increasingly greater with poorer efficiency of cognitive rehabilitation (odds ratio = 0.70). The odds of being discussed in team conferences were increasingly greater with more severe neglect (odds ratio = 0.98), and with longer stay in hospitalization (odds ratio = 1.06). Conclusions Multidisciplinary care may not involve as much interdisciplinary communication as needed to document important disease states. Stroke rehabilitation professionals should be able to recognize spatial neglect independently and document it consistently.

Assessment and Functional Impact of Allocentric Neglect: A Reminder from a Case Study

“…Since spatial neglect in general is under-represented in research and under-recognized in clinical practice, it is possible that individuals with such disorder do not receive focused rehabilitation (Chen, McKenna, Kutlik, & Frisina, 2012; Edwards et al, 2006). Rehabilitation outcomes of a treatment program may differ depending on the survivor’s spatial cognitive deficits (Pachalska, et al, 2004).…”

Spatial cognitive rehabilitation and motor recovery after stroke

“…Even if spatial retraining only improves motor recovery in patients with spatial neglect, it still has significant potential, because spatial neglect is likely under-identified (51; Figure 2). It is not surprising that spatial stimulation affects motor systems; visual-motor, integrative brain activity stimulates beneficial reorganization (52).…”

Functional Assessment of Spatial Neglect: A Review of the Catherine Bergego Scale and an Introduction of the Kessler Foundation Neglect Assessment Process

“…Lastly, in some contexts, neglect assessment may not be employed at all 22 , perhaps due to perceived barriers in the implementation of the assessment. In sum, clinical practice has not respected a consistent standard: some practitioners use behavioral tests (e.g., target cancellation, figure copying), some document clinical observations, and others make judgments about the presence and treatment of neglect based on a general evaluation rather than any specific cognitive testing 22–24 . This inconsistent practice standard may contribute to the low detection rate of spatial neglect in medical and rehabilitation settings, 25 and it hampers efforts to optimize stroke management and rehabilitation through neglect-specific therapeutic interventions 26,27 .…”