Abstract TP316: When Push Comes to Shove… Pulling is Better: Achieving Better Outcomes by Actively Seeking (Pulling) Stroke Patients for Rehabilitation
Background: The length of stay (LOS) of stroke patients in the acute hospital coming to our stroke rehabilitation unit (SRU) has remained largely unchanged despite increasing administrative pressure for earlier discharge in recent years. Reducing this LOS can ease bed pressure and may also improve patient outcome. We explore the effect of changing the model of stroke rehabilitation consultation from patients being referred (or “push”) by the acute team, to the SRU team actively seeking (or “pull”) patients prior to referral.
Methods: From November 2010 to December 2011, potential stroke rehabilitation patients were sought daily in targeted wards in Sir Charles Gairdner Hospital (our main referring hospital), lead by a consultant geriatrician. Patients were identified by screening the nurses’ hand over sheet, discussing with the treating medical and allied health team, and reviewing the patients and case notes. Patients were reviewed regularly until their rehabilitation/discharge plan is finalised. The patients’ characteristics and rehabilitation outcome over the two periods before and after service initiation were compared.
Results: Over the 14 months, 89 patients were admitted to our SRU, with an average acute hospital LOS of 12.5 days, a 5 days reduction compared to previous years (1996-October 2010: 17.9 days, n=716). The 89 patients were more disabled (average admission functional independence measure [FIM] 69 compare to 73), but with no worsening of outcome (including discharge FIM, FIM efficacy, FIM efficiency, LOS in SRU, % discharged home and mortality).
Discussion and Conclusion: The “pull” model in consultation avoids delays from administrative inefficiencies in referring a patient, and allows earlier involvement in discharge planning. This is likely to have contributed to the earlier rehabilitation admission. While this did not change the patients’ outcome, however, the reduction in acute hospital LOS has financial benefit (445 bed days and $800,000 AUD saved over this period). The earlier involvement in patients’ care also facilitates a more seamless transition to rehabilitation. In conclusion, ‘pulling’ patients for stroke rehabilitation is a cost-effective way to reduce LOS in the acute hospital, and may improve rehabilitation outcome.
- © 2012 by American Heart Association, Inc.