Determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review?

Poulos, Christopher J.; Eagar, Kathy

doi:10.1186/1743-8462-4-3

Cited by 26 publications

(30 citation statements)

References 32 publications

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“…4 The primary predictors for this discharge are funding rather than injury severity, with compensable patients having 10-fold higher odds of discharge to in-patient rehabilitation than those who are uninsured. 4 Recommended guidelines in terms of who would benefit from in-patient rehabilitation rather than discharge directly home are not currently available 5,6 and research suggests that patient selection is variable and often influenced by bed availability and system pressures. 6 Patient involvement in discharge decision-making appears to be the most significant factor in determining discharge disposition in the elective orthopaedic population, 7 and patient involvement in decision-making is shown to lead to greater satisfaction following acute hospital care.…”

Section: Introductionmentioning

confidence: 99%

“…4 Recommended guidelines in terms of who would benefit from in-patient rehabilitation rather than discharge directly home are not currently available 5,6 and research suggests that patient selection is variable and often influenced by bed availability and system pressures. 6 Patient involvement in discharge decision-making appears to be the most significant factor in determining discharge disposition in the elective orthopaedic population, 7 and patient involvement in decision-making is shown to lead to greater satisfaction following acute hospital care. 8 There are no studies on patient perspectives of discharge destination decisionmaking following orthopaedic trauma.…”

Section: Introductionmentioning

confidence: 99%

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Discharge from the acute hospital: trauma patients’ perceptions of care

Kimmel

Holland

Hart

et al. 2016

Aust. Health Review

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Objective. The involvement of orthopaedic trauma patients in the decision-making regarding discharge destination from the acute hospital and their perceptions of the care following discharge are poorly understood. The aim of the present study was to investigate orthopaedic trauma patient experiences of discharge from the acute hospital and transition back into the community.Methods. The present qualitative study performed in-depth interviews, between October 2012 and November 2013, with patients aged 18-64 years with lower limb trauma. Thematic analysis was used to derive important themes.Results. Ninety-four patients were interviewed, including 35 discharged to in-patient rehabilitation. Key themes that emerged include variable involvement in decision-making regarding discharge, lack of information and follow-up care on discharge and varying opinions regarding in-patient rehabilitation. Readiness for discharge from in-patient rehabilitation also differed widely among patients, with patients often reporting being ready for discharge before the planned discharge date and feeling frustration at the need to stay in in-patient care. There was also a difference in patients' perception of the factors leading to recovery, with patients discharged to rehabilitation more commonly reporting external factors, such as rehabilitation providers and physiotherapy.Conclusion. The insights provided by the participants in the present study will help us improve our discharge practice, especially the need to address the concerns of inadequate information provision regarding discharge and the role of inpatient rehabilitation.What is known about the topic? There is no current literature describing trauma patient involvement in decision-making regarding discharge from the acute hospital and the perception of how this decision (and destination choice; e.g. home or in-patient rehabilitation) affects their outcome. HEALTH SERVICE RESEARCH What does this paper add?The present large qualitative study provides information on patients' opinion of discharge from the acute hospital following trauma and how this could be improved from their perception. Patients are especially concerned with the lack of information provided to them on discharge, their lack of involvement and understanding of the choices made with regard to their discharge and describe concerns regarding their follow-up care. There is also a feeling from the patients that they are ready to leave rehabilitation before their actual planned discharge date, a concept that needs further investigation. What are the implications for practitioners? The patient insights gained by the present study will lead to a change in discharge practice, including increased involvement of the patient in the decision-making in terms of discharge from both the acute and rehabilitation hospitals and a raised awareness of the need to provide written information and follow-up telephone calls to patients following discharge. Further research into many aspects of patient discharge from the acute hosp...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Discharge from the acute hospital: trauma patients’ perceptions of care

Kimmel

Holland

Hart

et al. 2016

Aust. Health Review

View full text Add to dashboard Cite

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“…5 A recent literature review by New 6 specifically emphasizes the point that there is limited information in current literature to guide or standardize the decision-making in rehabilitation assessment. The general opinion is that the process of patient selection remains a subjective practice, [7][8][9] which relies predominantly on clinical judgment and is influenced by system factors such as rehabilitation bed availability and pressure on acute care.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with patient selection for inpatient rehabilitation: an audit of decision-making in the rehabilitation assessment

Lim¹,

Чурилов²,

Smith³

et al. 2013

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Background: Assessment of patients for their potential to participate and benefit from inpatient rehabilitation forms an integral component of the practice of rehabilitation medicine. There is limited information in the current literature to guide or standardize the decision-making in rehabilitation assessment. Setting: Inpatient rehabilitation unit within a major tertiary public hospital in metropolitan Melbourne, Australia. Objective: To determine which information routinely collected during the rehabilitation assessment is associated with the likelihood of a patient being accepted for inpatient rehabilitation. Design: A retrospective audit of consecutive rehabilitation assessments carried out over a 4-month period. Methods: Multivariable association between patient clinical and demographic characteristics and the likelihood of being accepted for inpatient rehabilitation was assessed for 219 acute inpatients referred to the inpatient rehabilitation unit. Results: Of the 219 patients, 74.9% were accepted for inpatient rehabilitation. There were statistically significant deficits in cognition, continence, personal care, and mobility at the time of patients' assessment for inpatient rehabilitation. Patients' premorbid level of independence with personal activities of daily living (PADLs) (P = 0.006) and continence (P = 0.04), as well as "at the time of assessment" need for assistance with PADLs (P , 0.001), mobility (P = 0.004), incontinence (P = 0.01), and impaired cognition (P , 0.001), were associated with the likelihood of being accepted for inpatient rehabilitation. Conclusion: Premorbid dependence with PADLs and current impaired cognition as well as incontinence reduce the likelihood of patient selection, while present dependence with PADLs and mobility increase the likelihood of patient admission. Our findings provide researchers, clinicians, and health managers with empirical evidence regarding the process of patient selection for inpatient rehabilitation.

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“…An emergent theme is that a subgroup of patients exists whose health care needs are no longer acute and directly influenced by their original principal medical diagnosis, but instead their health care needs are predicted by their functional status [1][2][3][4][5][6]. The most readily recognised type of subacute care is rehabilitation [1]. Rehabilitation commonly refers to medically directed multi-disciplinary services that aim to improve an individual's function [3].…”

Section: Introductionmentioning

confidence: 99%

“…Rehabilitation commonly refers to medically directed multi-disciplinary services that aim to improve an individual's function [3]. These services are based on an evidence-based comprehensive assessment of function and negotiated patient goals [1][2][3].…”

Section: Introductionmentioning

confidence: 99%