1619 - Weekend Coverage: Improving Plan of Care Compliance on Weekends in a Community Inpatient Rehab Facility After New EMR Rollout

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CK

Catherine M. Kingry, MD

Resident Physician
Texas Rehabilitation Hospital of Fort Worth
Fort Worth, Texas, United States

Co-Author(s)

CW

Cameron Williams, DO

Resident Physician
Texas Rehabilitation Hospital of Fort Worth
Fort Worth, Texas, United States
AM

Amanda N. Moore, PharmD

Director of Quality Management
Texas Rehabilitation Hospital of Fort Worth
Hudson Oaks, Texas, United States

Submitter(s)

CK

Catherine M. Kingry, MD

Texas Rehabilitation Hospital of Fort Worth
Fort Worth, Texas, United States

Objectives: Maintaining CMS standards compliance in the IRF setting is paramount to hospital funding and caring for patients with rehabilitation needs. When our hospital EMR, and the Individualized Overall Plans of Care (IOPOC) signing process, changed, IOPOC compliance significantly dropped if the 4th day of admission was over the weekend. Our objective was to increase the percentage of IOPOC’s completed to 100% when due over a weekend.

Design: A before-after study to evaluate IOPOC completion at a single free-standing private IRF. Interventions included implementing a ‘Proxy’ function within Cerner EMR, allowing physicians to sign IOPOC’s for another when on-call during weekends, and utilizing automated highlighting of patients’ names on Microsoft Excel rounding sheet when IOPOC is due. Physicians were educated on both interventions, performed 2.5 months apart. Follow-up data was collected over 2.5 to 3 months after interventions. Main outcome measures were overall number and percentage of IOPOC’s signed by physicians within the standard 4-day timeframe, stratified by weekend and weekday IOPOC due dates.

Results: 1486 IOPOC’s were analyzed over 14 months. ANOVA was used to determine significance. Prior to EMR transition, IOPOC compliance was 91% on weekday due dates and 96.7% on weekend due dates (p-value 0.049). Post-EMR transition, compliance dropped to 89.7% on weekdays and 76.6% on weekends (p-value 0.0000096). With Proxy intervention, completion was 85.7% on weekdays and 77.3% on weekends (p-value 0.069). With highlighted list intervention, compliance improved to 92.7% on weekdays and 90.6% on weekends (p-value 0.625).

Conclusions: The highlighted list intervention showed improvement in IOPOC completion over the weekends, with no significant difference in compliance between weekends and weekday due dates or between pre-EMR transition and list intervention. However, we did not meet our goal of reaching 100% compliance. Future interventions might be tailored to individual physicians’ practice styles, especially physicians providing coverage exclusively during weekends or vacations.