Implementation of an in-reach rehabilitation program can increase the rate of discharge home from acute hospital care
Jane Wu A B * , Christine T. Shiner A B , Steven G. Faux A B and Yuriko Watanabe A BA Department of Rehabilitation, St Vincent’s Hospital Sydney, 170 Darlinghurst Road, Darlinghurst, NSW, Australia.
B Faculty of Medicine, St Vincent’s Clinical School, University of New South Wales, Sydney, NSW, Australia.
Australian Health Review 47(5) 619-625 https://doi.org/10.1071/AH23033
Submitted: 24 February 2023 Accepted: 28 June 2023 Published: 18 July 2023
Abstract
This study describes how a model of early rehabilitation (‘in-reach rehabilitation’) can be integrated into acute care provision for hospitalised patients with high rehabilitation needs. This pragmatic evaluation aimed to assess service impact on home discharge rates from acute care.
An integrated early rehabilitation service was implemented at a tertiary teaching hospital in Sydney, Australia. Eligible patients were screened, placed on a waitlist, and treated in order of debility (six to eight patients concurrently). Routine data were collected and compared between those who received an in-reach rehabilitation program, and controls who remained on waitlist.
From December 2021 to September 2022, 229 patients were identified as suitable for in-reach rehabilitation; of whom 100 received an in-reach program and the remaining 129 were waitlist controls. Patients who received in-reach rehabilitation achieved a significantly higher rate of discharge home from acute care compared to waitlist controls (46.0% vs 24.0%, P = 0.002) and lower rates of transfer to subacute inpatient rehabilitation (43.0% vs 62.0%). This was despite in-reach patients having high functional care needs (60% needed assistance from ≥two people to mobilise) and complex medical needs (median hospital length of stay 44.5 days, IQR 27.8–66.0).
It is feasible to deliver in-reach rehabilitation to hospitalised patients with heterogeneous diagnoses who have high rehabilitation needs. The rate of discharge home directly from acute wards is higher among those patients who received early in-reach rehabilitation compared to those on a waitlist.
Keywords: acute care, clinical services, health services research, hospitals, models of care, performance and evaluation, rehabilitation.
References
1 Ahmed NN, Pearce SE. Acute care for the elderly: a literature review. Popul Health Manag 2010; 13(4): 219-25.
| Crossref | Google Scholar |
2 Ranhoff AH, Saltvedt I, Frihagen F, Raeder J, Maini S, Sletvold O. Interdisciplinary care of hip fractures.: Orthogeriatric models, alternative models, interdisciplinary teamwork. Best Pract Res Clin Rheumatol 2019; 33(2): 205-26.
| Crossref | Google Scholar |
3 Kosse NM, Dutmer AL, Dasenbrock L, Bauer JM, Lamoth CJ. Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review. BMC Geriatr 2013; 13(1): 107.
| Crossref | Google Scholar |
4 Mak J, Wong E, Cameron I. Australian and New Zealand Society for Geriatric Medicine: Position statement – orthogeriatric care. Australas J Ageing 2011; 30(3): 162-9.
| Crossref | Google Scholar |
5 Langhorne P, Ramachandra S, Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke: network meta-analysis. Cochrane Database Syst Rev 2020; 4(4): CD000197.
| Crossref | Google Scholar | PubMed |
6 Langhorne P, Pollock A, In Conjunction with The Stroke Unit Trialists’ Collaboration. What are the components of effective stroke unit care? Age Ageing 2002; 31(5): 365-71.
| Crossref | Google Scholar |
7 Agency for Clinical Innovation. NSW Rehabilitation Model of Care. 2015. Available at https://aci.health.nsw.gov.au/media/documents/networks/rehabilitation/NSW-Rehabilitation-MOC.pdf [accessed 24 April 2023].
8 Eghbali M, Khankeh H, Ebadi A. The importance of early rehabilitation in traumatic brain injury. Nurs Prac Today 2020; 7(2): 84-6.
| Crossref | Google Scholar |
9 Nas K, Yazmalar L, Şah V, Aydın A, Öneş K. Rehabilitation of spinal cord injuries. World J Orthop 2015; 6(1): 8-16.
| Crossref | Google Scholar |
10 Lang JK, Paykel MS, Haines KJ, Hodgson CL. Clinical practice guidelines for early mobilization in the ICU: a systematic review. Crit Care Med 2020; 48(11): e1121-8.
| Crossref | Google Scholar |
11 National Institute for Health and Care Excellence. NICE guidelines 2022 Rehabilitation after traumatic injury. 18 January 2022. Available at https://www.nice.org.uk/guidance/ng211 [accessed 22 April 2023].
12 Wade D. Rehabilitation – a new approach. Overview and Part One: the problems. Clin Rehabil 2015; 29(11): 1041-50.
| Crossref | Google Scholar |
13 Wade D. Rehabilitation – a new approach. Part four: a new paradigm, and its implications. Clin Rehabil 2016; 30(2): 109-18.
| Crossref | Google Scholar |
14 Suriyaarachchi P, Chu L, Bishop A, Thew T, Matthews K, Cowan R, Gunawardene P, Duque G. Evaluating Effectiveness of an Acute Rehabilitation Program in Hospital-Associated Deconditioning. J Geriatr Phys Ther 2020; 43(4): 172-8.
| Crossref | Google Scholar |
15 Wu J, Faux SG, Estell J, Wilson S, Harris I, Poulos CJ, et al. Early rehabilitation after hospital admission for road trauma using an in-reach multidisciplinary team: a randomised controlled trial. Clin Rehabil 2017; 31(9): 1189-200.
| Crossref | Google Scholar |
16 Wu J, Vratsistas-Curto A, Shiner CT, Faux SG, Harris I, Poulos CJ. Can in-reach multidisciplinary rehabilitation in the acute ward improve outcomes for critical care survivors? A pilot randomized controlled trial. J Rehabil Med 2019; 51: 598-606.
| Crossref | Google Scholar |
17 Wu J, Misa O, Shiner CT, Faux SG. Targeted rehabilitation may improve patient flow and outcomes: development and implementation of a novel Proactive Rehabilitation Screening (PReS) service. BMJ Open Qual 2021; 10: e001267.
| Crossref | Google Scholar |
18 Dodds TA, Martin DP, Stolov WC, Deyo RA. A validation of the functional independence measurement and its performance among rehabilitation inpatients. Arch Phys Med Rehabil 1993; 74(5): 531-6.
| Crossref | Google Scholar |
19 Barnett SD, Heinemann AW, Libin A, et al. Small N designs for rehabilitation research. J Rehabil Res Dev 2012; 49: 175-86.
| Crossref | Google Scholar |
20 Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: a1655.
| Crossref | Google Scholar |
21 Beninato M, Gill-Body KM, Salles S, Stark PC, Black-Schaffer RM, Stein J. Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. Arch Phys Med Rehabil 2006; 87(1): 32-9.
| Crossref | Google Scholar | PubMed |
22 Alexander TL, Simmonds FD, Capell JT, Green LJ. The AROC annual report: The state of rehabilitation in Australia in 2018 (Australasian Rehabilitation Outcomes Centre, Australian Health Services Research Institute, University of Wollongong, 2019). Available at https://ahsri.uow.edu.au/aroc/reports/index.html [accessed 24 January 2023].
23 Reistetter TA, Graham JE, Deutsch A, Granger CV, Markello S, Ottenbacher KJ. Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke. Arch Phys Med Rehabil 2010; 91(3): 345-50.
| Crossref | Google Scholar |
