Factors associated with unplanned transfers among cancer patients at a freestanding acute rehabilitation facility

Abstract

Background: Cancer patients undergoing inpatient rehabilitation often have high risk of complications leading to unplanned transfer to acute care. Prior studies have identified factors associated with these transfers but have been limited to examining factors that pertain to initial admission to rehabilitation and were not conducted in a freestanding inpatient rehabilitation facility.Objective: The study aimed to include these prerehabilitation factors in addition to factors upon initial assessment in rehabilitation. It was hypothesized that specific factors from each of these periods would be associated with unplanned transfer to acute care. Design: Retrospective cohort study. Setting: Freestanding academic inpatient rehabilitation facility affiliated with an academic tertiary care facility with a comprehensive cancer center. Patients: Retrospective review of 330 specific encounters unique to 250 patients from March 2017 to September 2018. Main Outcome Measures: The outcome measure was unplanned transfer to acute care. A binary logistic regression model was used to examine the relationship between factors from oncologic history, acute care course, and factors upon admission to rehabilitation to unplanned transfer to acute care. Results: From 330 encounters, there were 111 unplanned transfers (34%). Unplanned transfer to acute care was independently associated with gastrointestinal malignancy (odds ratio [OR] 4.4, p = .01), 6-minute walk test less than 90 m (OR 4.6, p = .003), and prior unplanned transfer (OR 3.5, p = .007). Conclusions:The study suggests that oncologic and functional prerehabilitation markers are associated with an increased likelihood of unplanned transfer during inpatient cancer rehabilitation. These findings will provide a framework for creating predictive tools for unplanned transfers in cancer rehabilitation patients.

Factors Associated with Unplanned Transfer of Patients with Brain Tumor from Inpatient Rehabilitation Unit to Primary Acute Care Units

“…Therefore, patients with subacute stroke were chosen and analyzed as a control group for patients with brain tumor in this study. Patients with brain tumor were younger than patients with subacute stroke in this study, similar to findings of previous studies [ 20 , 21 ] showing that the mean age was 53.3 years for those diagnosed with a brain tumor and 69.2 years for those diagnosed with a stroke. Proportions of comorbidities such as hypertension, diabetes mellitus (DM), and hyperlipidemia were higher in patients with subacute stroke, consistent with previous study results showing that stroke-related comorbidities were the most common in the order of hypertension, DM, and hyperlipidemia [ 22 , 23 ].…”

Frequency and reasons for unplanned transfer to the primary acute care service of inpatient rehabilitation glioblastoma multiforme patients

“…Infection has been found to be the most common reason for transfer back to the primary acute care service of cancer acute rehabilitation inpatients in multiple studies. 9,13,14,15,16,17 However, only 2/15 (13.3%) patients in our study returned to the primary acute care service due to infection. One was a wound infection (categorized under neurosurgical complications) and the other was an aspiration pneumonia.…”

“…Foley catheters are often present in low functioning patients due to the di culty with transfers and mobility to the bathroom or commode. Previous studies of acute inpatient rehabilitation general cancer populations have also found relationships with lower function and transfer to the primary acute care service including studies by Bhakta et al 13 (lower 6 minute walk test) and Asher et al 10 (lower Motor FIM which includes all FIM items except the last 5 items related to cognition/communication). A similar relationship with lower admission functional level and the likelihood of medical complications and/or transfer to the primary acute care service was found in four stroke acute inpatient rehabilitation studies.…”

“…7,8 Multiple researchers have explored the topic of risk factors for transfer back to the primary acute care service of general cancer patients from IRF's (reported between 17-35%). 9,10,11,12,13 Additional research on the transfer rate from IRF to the primary acute care service for speci c primary cancer types has also been published. This research has focused mostly on hematologic malignancies who are amongst the most medically fragile.…”

Inpatient Rehabilitation of Hematopoietic Stem Cell Transplant Patients

“…41 Hematologic malignancies and stem cell transplant patients have been recognized as among the most medically fragile cancer rehabilitation populations with some of the highest rates of return to the primary acute care service. 42 Transfer rates of 28% for hematologic malignancies, 43 37% for leukemia, 44 38% for lymphoma, 45 and 26% for multiple myeloma 46 have been reported.…”