EARLY PHYSICAL THERAPY CONSULTATION IN REDUCING LENGTH OF STAY AND
MEDICAL COSTS IN A PATIENT WITH BENIGN PAROXYSMAL POSITIONAL VERTIGO
(BPPV): A CASE REPORT. Kelly Duszak McArdle1Hyon, Alicia2. 1,2Mercy Philadelphia Hospital, 501
Philadelphia, PA. 19143.
Background/Purpose: Patients (Pt’s) with balance disorders and dizziness frequently seek emergency
room(ER) care and are admitted for short term hospitalizations. Current research supports early Physical
Therapy (PT) consultation and treatment in decreasing admissions, length of stay, and medical costs.
Acute care PT’s are not always consulted early for patients with complaints of dizziness or decreased
balance leading to overall increased medical testing and expenses or even unnecessary hospitalizations
which are already on the rise in this population. This case report illustrates the importance of early PT
consultation in evaluating and treating a patient with complaints of dizziness due to BPPV in reducing
overall costs of healthcare services and length of hospitalization. Case Description: Pt was a 70 yearold AAF admitted with complaints of dizziness exacerbated by movement, vomiting, unsteady gait, and
intermittent headache for 2 days. Medical testing consisted of blood work, MRI and MRA of the brain
and neck, x-rays of the neck, and neurology and cardiology consultations; all testing was negative. PT
was consulted on the third admission day. A mobility PT examination was performed with the pt
independent in all functional mobility without impairments, except for complaints of dizziness at rest
and with movement. A PT vestibular examination was recommended and ordered on the fourth
admission day. Vestibulo-ocular, balance, and Modified CTSIB testing were negative. The Dizziness
Handicap Inventory (DHI) revealed moderate handicap. The Hallpike Dix was completed to both sides
and positive for left posterior semicircular canalithiasis. Outcomes: The pt was given a PT diagnosis of
left BPPV and treated with the Epley Maneuver twice. Symptoms of dizziness at rest and with
functional mobility resolved. She was instructed to perform a self Epley Maneuver twice daily until
symptoms resolved for two straight days and discharge was recommended. Pt was discharged from the
hospital on the fifth day of admission. Conclusion: Total cost of this five-day acute care stay was
$17,344, averaging $3,468 daily. This included radiological testing costs of $10,212 ordered prior to
referral for PT. PT’s are utilized early in the ER or acute care in orthopedic and neurological cases to
facilitate patient disposition, control costs and length of stay and to maximize a pt’s mobility and
independence. They also educate pt’s in follow up management, further decreasing costs and repeat
hospitalizations which are areas of concern in the acute care. This case demonstrates how acute care
PT’s may be better utilized in the care of pt’s with balance disorders and dizziness to address early
access, quality of care, and cost control. It also supports APTA’s Vision 2020 and role of PT’s as
autonomous practitioners of choice by the medical community and consumers in diagnosing, preventing
impairments, and implementing interventions related to movement, function, and environmental
barriers.
kduszak@mercyhealth.org
Case Report (Poster)