The Assessment and Selection of Potential Rehabilitation Patients in Acute Hospitals: A Literature Review and Commentary

New, Peter W

doi:10.2174/1874943700902010024

Cited by 30 publications

(35 citation statements)

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“…These strategies should be designed to shorten the time between admission into acute hospital and rehabilitation referral. A case has been made for a change to the model of care typically provided by rehabilitation physicians in acute hospitals, from a triage or gatekeeper model to a ‘pull’ model involving shared care between rehabilitation and acute hospital staff or an ‘inreach’ team from rehabilitation working in an acute hospital . These models involve the early assessment of rehabilitation needs (even while patients are not fully stable) by a multidisciplinary rehabilitation team advising acute hospital staff so that patients receive appropriate prevention of deconditioning and other disability‐related complications; therapy commensurate with what patients can tolerate; earlier commencement of discharge planning and re‐directing patients to ambulatory rehabilitation programmes where available and appropriate.…”

Section: Discussionmentioning

confidence: 99%

“…A case has been made for a change to the model of care typically provided by rehabilitation physicians in acute hospitals, from a triage or gatekeeper model to a 'pull' model involving shared care between rehabilitation and acute hospital staff or an 'inreach' team from rehabilitation working in an acute hospital. 11,17 These models involve the early assessment of rehabilitation needs (even while patients are not fully stable) by a multidisciplinary rehabilitation team advising acute hospital staff so that patients receive appropriate prevention of deconditioning and other disability-related complications; therapy commensurate with what patients can tolerate; earlier commencement of discharge planning and re-directing patients to ambulatory rehabilitation programmes where available and appropriate. This would have the potential to deliver major improvements in patient flow from acute hospital to rehabilitation, reduce preventable complications that result in patient harm and increase acute and rehabilitation LOS 11,17 , and would be amenable to formal testing in a clinical trial.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reducing the length of stay for acute hospital patients needing admission into inpatient rehabilitation: a multicentre study of process barriers

New

Andrianopoulos

Cameron

et al. 2013

Internal Medicine Journal

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reducing the length of stay for acute hospital patients needing admission into inpatient rehabilitation: a multicentre study of process barriers

New

Andrianopoulos

Cameron

et al. 2013

Internal Medicine Journal

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“…The optimal time for a patient to be transferred to rehabilitation and the implications of locating rehabilitation facilities away from acute hospital campuses need to be considered [4]. …”

Section: Introductionmentioning

confidence: 99%

Determining level of care appropriateness in the patient journey from acute care to rehabilitation

Poulos

Magee

Bashford³

et al. 2011

BMC Health Serv Res

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BackgroundThe selection of patients for rehabilitation, and the timing of transfer from acute care, are important clinical decisions that impact on care quality and patient flow. This paper reports utilization review data on inpatients in acute care with stroke, hip fracture or elective joint replacement, and other inpatients referred for rehabilitation. It examines reasons why acute level of care criteria are not met and explores differences in decision making between acute care and rehabilitation teams around patient appropriateness and readiness for transfer.MethodsCohort study of patients in a large acute referral hospital in Australia followed with the InterQual utilization review tool, modified to also include reasons why utilization criteria are not met. Additional data on team decision making about appropriateness for rehabilitation, and readiness for transfer, were collected on a subset of patients.ResultsThere were 696 episodes of care (7189 bed days). Days meeting acute level of care criteria were 56% (stroke, hip fracture and joint replacement patients) and 33% (other patients, from the time of referral). Most inappropriate days in acute care were due to delays in processes/scheduling (45%) or being more appropriate for rehabilitation or lower level of care (30%).On the subset of patients, the acute care team and the utilization review tool deemed patients ready for rehabilitation transfer earlier than the rehabilitation team (means of 1.4, 1.3 and 4.0 days from the date of referral, respectively). From when deemed medically stable for transfer by the acute care team, 28% of patients became unstable. From when deemed stable by the rehabilitation team or utilization review, 9% and 11%, respectively, became unstable.ConclusionsA high proportion of patient days did not meet acute level of care criteria, due predominantly to inefficiencies in care processes, or to patients being more appropriate for an alternative level of care, including rehabilitation. The rehabilitation team was the most accurate in determining ongoing medical stability, but at the cost of a longer acute stay.To avoid inpatients remaining in acute care in a state of 'terra nullius', clinical models which provide rehabilitation within acute care, and more efficient movement to a rehabilitation setting, is required. Utilization review could have a decision support role in the determination of medical stability.

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“…Nonmedical factors that influence patient selection include social factors such as availability and reliability of discharge supports; financial issues, including insurance coverage and bed availability; 3,4 and past experiences of the assessor or rehabilitation unit. 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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The Assessment and Selection of Potential Rehabilitation Patients in Acute Hospitals: A Literature Review and Commentary

Abstract: Objective: Literature review on the assessment and selection of adults in acute hospitals regarding the need for inpatient rehabilitation.

Cited by 30 publications

References 40 publications

Reducing the length of stay for acute hospital patients needing admission into inpatient rehabilitation: a multicentre study of process barriers

Reducing the length of stay for acute hospital patients needing admission into inpatient rehabilitation: a multicentre study of process barriers

Determining level of care appropriateness in the patient journey from acute care to rehabilitation

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

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