Measuring Discharge Outcomes, Length of Stay, and Functional ADL Score During COVID-19 in Inpatient Rehabilitation Hospitals

Hartsgrove, Caitlin; Guevarra-Fernández, Jenieve; Kendall, Jamila A.; Delauter, Gabrielle; Kirshblum, Steven

doi:10.1016/j.apmr.2021.07.003

Cited by 15 publications

(17 citation statements)

References 39 publications

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“… 15 , 16 , 17 , 30 , 31 , 32 However, this study did not explore the implementation of specific rehabilitation therapies for patients recovering from COVID and additional research is needed to understand both the types of therapies and how best to implement them in this adapted context for patients recovering from acute infections as well as long COVID. 1 , 8 , 10 , 41 , 42 , 43…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…One family caregiver (CG10) also worked as a frontline nurse at the IRH, and relevant quotes that pertained to implementation are included in the current analysis. Occupational therapist (OT) Uses everyday activities and occupations to treat the physical, mental, developmental and emotional ailments that impact a patient's ability to perform day-to-day tasks 3 (35) Patient care manager (PCM) Supervises a clinical team and are responsible for the direction of patient care 2 (17) Registered nurse (RN) Assesses, identifies, plans, implements, and evaluates the nursing care required to assist patients in meeting their physical, social, spiritual and psychological needs 2 (17) Pharmacist Prepares and dispenses prescription medications and educates patients and families on the safe and effective use of medications 1 (8) Medical department head (MDH) Responsible for medical supervision and overseeing daily operations in their respective departments 2 (17) Professional practice leader (PPL) Oversees and supervises clinical and professional practice, and develops and supports patient care and education through mentorship, consultation, and acting as a resource for staff 2 (17) focused on successes and challenges working on the unit, supports received, and the quality of care delivered to patients. Data were collected until saturation was reached.…”

Section: Data Collectionmentioning

confidence: 99%

“…[15][16][17][30][31][32] However, this study did not explore the implementation of specific rehabilitation therapies for patients recovering from COVID and additional research is needed to understand both the types of therapies and how best to implement them in this adapted context for patients recovering from acute infections as well as long COVID. 1,8,10,[41][42][43] The COVID zone was adapted in July 2021 once it was understood that cohorting patients recovering from COVID was no longer needed. While changes in IPAC measures will address some implementation barriers identified in the current study (e.g., increased access to equipment and reintroduction of family caregivers into the hospital setting), others (such as access to information and staff selfefficacy) will require additional considerations.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Patients recovering from significant COVID‐19 infections (COVID) commonly experience long‐term physical, cognitive and psychosocial impairments that negatively impact daily functioning and quality of life. 1 , 2 , 3 Therefore, many patients hospitalized with COVID require subsequent in‐patient rehabilitation 4 , 5 , 6 to promote recovery, improve health outcomes 7 , 8 and facilitate community reintegration. 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

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Implementation considerations for delivering inpatient COVID rehabilitation: A qualitative study

Sheppard

Szigeti

Simpson

et al. 2022

Evaluation Clinical Practice

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Rationale Patients recovering from significant COVID‐19 infections benefit from rehabilitation; however, aspects of rehabilitative care can be difficult to implement amidst COVID infection control measures. Aims and Objectives We used the Consolidated Framework for Implementation Research (CFIR) to evaluate the rapid implementation of a COVID zone in an in‐patient rehabilitation hospital at the onset of the first wave of the pandemic. Methods Semistructured interviews were conducted with health care providers ( n = 12) supporting the COVID zone, as well as with patients ( n = 10) who were discharged from the COVID zone and their family caregivers ( n = 5). The interviews explored the successes and challenges of working on the unit and the quality of care that was delivered to patients recovering from COVID. Results Rapid implementation of the COVID zone was supported by champions at the middle‐management level but challenged by a number of factors, including: conflicting expert opinions on best infection control practices (outer setting), limited flow of information from senior leaders to frontline staff (inner setting), lack of rehabilitation equipment and understanding of how to provide high quality rehabilitative care in this context (intervention characteristics), willingness and self‐efficacy of staff working in the COVID zone (individual characteristics) and lack of time to reflect on and assess effectiveness (process). Conclusions While there was an apparent need for rapid implementation of a COVID rehabilitation zone, senior leadership, middle management and frontline staff faced several challenges. Future evaluations should focus on how to adapt COVID rehabilitation services during fluctuating pandemic restrictions, and to account for rehabilitative needs of people recovering from significant COVID infections.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Implementation considerations for delivering inpatient COVID rehabilitation: A qualitative study

Sheppard

Szigeti

Simpson

et al. 2022

Evaluation Clinical Practice

View full text Add to dashboard Cite

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“…It has been proposed that patients with severe COVID-19 may benefit from the inpatient respiratory, functional, and neurological rehabilitation provided at LTACHs [ 5 ]. Early rehabilitation may also reduce disability and improve clinical outcomes in patients with COVID-19 [ 6 - 9 ].…”

Section: Introductionmentioning

confidence: 99%

Patient Outcomes and Lessons Learned From Treating Patients With Severe COVID-19 at a Long-term Acute Care Hospital: Single-Center Retrospective Study

Grevelding¹,

Hrdlicka²,

Holland³

et al. 2022

JMIR Rehabil Assist Technol

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Background With the continuation of the COVID-19 pandemic, shifting active COVID-19 care from short-term acute care hospitals (STACHs) to long-term acute care hospitals (LTACHs) could decrease STACH census during critical stages of the pandemic and maximize limited resources. Objective This study aimed to describe the characteristics, clinical management, and patient outcomes during and after the acute COVID-19 phase in an LTACH in the Northeastern United States. Methods This was a single-center group comparative retrospective analysis of the electronic medical records of patients treated for COVID-19–related impairments from March 19, 2020, through August 14, 2020, and a reference population of medically complex patients discharged between December 1, 2019, and February 29, 2020. This study was conducted to evaluate patient outcomes in response to the holistic treatment approach of the facility. Results Of the 127 total COVID-19 admissions, 118 patients were discharged by the data cutoff. At admission, 29.9% (38/127) of patients tested positive for SARS-CoV-2 infection. The mean age of the COVID-19 cohort was lower than that of the reference cohort (63.3, 95% CI 61.1-65.4 vs 65.5, 95% CI 63.2-67.8 years; P=.04). There were similar proportions of males and females between cohorts (P=.38); however, the proportion of non-White/non-Caucasian patients was higher in the COVID-19 cohort than in the reference cohort (odds ratio 2.79, 95% CI 1.5-5.2; P=.001). The mean length of stay in the COVID-19 cohort was similar to that in the reference cohort (25.5, 95% CI 23.2-27.9 vs 29.9, 95% CI 24.7-35.2 days; P=.84). Interestingly, a positive correlation between patient age and length of stay was observed in the COVID-19 cohort (r2=0.05; P=.02), but not in the reference cohort. Ambulation assistance scores improved in both the reference and COVID-19 cohorts from admission to discharge (P<.001). However, the mean assistance score was greater in the COVID-19 cohort than in the reference cohort at discharge (4.9, 95% CI 4.6-5.3 vs 4.1, 95% CI 3.7-4.7; P=.001). Similarly, the mean change in gait distance was greater in the COVID-19 cohort than in the reference cohort (221.1, 95% CI 163.2-279.2 vs 146.4, 95% CI 85.6-207.3 feet; P<.001). Of the 16 patients mechanically ventilated at admission, 94% (15/16) were weaned before discharge (mean 11.3 days). Of the 75 patients admitted with a restricted diet, 75% (56/75) were discharged on a regular diet. Conclusions The majority of patients treated at the LTACH for severe COVID-19 and related complications benefited from coordinated care and rehabilitation. In comparison to the reference cohort, patients treated for COVID-19 were discharged with greater improvements in ambulation distance and assistance needs during a similar length of stay. These findings indicate that other patients with COVID-19 would benefit from care in an LTACH.

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Social determinants of health and COVID‐19 recovery after inpatient rehabilitation

Martin,

Lewis,

Dreyer

et al. 2024

PM&R

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BackgroundNeighborhoods with more social determinants of health (SDOH) risk factors have higher rates of infectivity, morbidity, and mortality from COVID‐19. Patients with severe COVID‐19 infection can have long‐term functional deficits leading to lower quality of life (QoL) and independence measures. Research shows that these patients benefit greatly from inpatient rehabilitation facilities (IRF) admission, but there remains a lack of studies investigating long‐term benefits of rehabilitation once patients are returned to their home environment.ObjectiveTo determine SDOH factors related to long‐term independence and QoL of COVID‐19 patients after IRF stay.DesignMultisite cross‐sectional survey.SettingTwo urban IRFs.Main Outcome MeasuresPrimary outcome measures were Post‐COVID Functional Status Scale (PCFS) and Short Form‐36 (SF‐36) scores. Secondary outcomes were quality indicator (QI) scores while at IRF and a health care access questionnaire. Results were analyzed using analysis of variance and multivariate logistic regression analyses.ResultsParticipants (n = 48) who were greater than 1 year post‐IRF stay for severe COVID‐19 were enrolled in the study. Higher SF‐36 scores were associated with male gender (p = .002), higher income (≥$70,000, p = .004), and living in the city (p = .046). Similarly, patients who were of the male gender (p = .004) and had higher income (≥$70,000, p = .04) had a greater odds of a 0 or 1 on the PCFS. Age was not associated with differences. Women were more likely to seek follow‐up care (p = .014). Those who sought follow‐up care reported lower SF‐36 overall and emotional wellness scores, p = .041 and p = .007, respectively. Commonly reported barriers to health care access were financial and time constraints.ConclusionsPatients with SDOH risk factors need to be supported in the outpatient setting to maintain functional gains made during IRF stays. Female gender, income, and urban setting are potential predictors for long‐term QoL and independence deficits after rehabilitation for COVID‐19 infection. Low emotional wellness is an indicator for patients to seek out care as far out as 1 year from their rehabilitation stay.

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Measuring Discharge Outcomes, Length of Stay, and Functional ADL Score During COVID-19 in Inpatient Rehabilitation Hospitals

Cited by 15 publications

References 39 publications

Implementation considerations for delivering inpatient COVID rehabilitation: A qualitative study

Implementation considerations for delivering inpatient COVID rehabilitation: A qualitative study

Patient Outcomes and Lessons Learned From Treating Patients With Severe COVID-19 at a Long-term Acute Care Hospital: Single-Center Retrospective Study

Social determinants of health and COVID‐19 recovery after inpatient rehabilitation

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