Readmission to acute care (RTAC) from inpatient rehabilitation can have negative consequences for individuals and associated financial costs are increasing. Consequently, preventing avoidable RTAC represents a target for improvement in quality of care. The aim of this integrative review was to identify predictors of RTAC from inpatient rehabilitation. A systematic search of MEDLINE, EMBASE, ProQuest, and CINAHL databases was used. Thematic analysis was used to examine extracted data. Strong evidence indicating that the principal predictors of RTAC are lower functional status on admission to rehabilitation, a more severe injury and a higher number of comorbidities was identified in this review. This is despite the heterogeneous nature of impairment groups and factors/measures examined. However, the relevance of some predictors of RTAC (such as patient demographics, invasive devices and primary diagnoses) may be dependent on rehabilitation setting, impairment group or time between rehabilitation admission and RTAC (eg, below 3 vs 30 days). Consequently, findings of this integrative review highlight that RTAC is a complex, multifactorial patient issue with a complex interplay between the predictors and reasons for RTAC.
In the TBI rehabilitation setting, falls result from a combination of many patient factors. Some factors are believed to be more relevant at different time points over a 24-h day and, at particular times during the course of a patient's rehabilitation. The utility and statistical significance of risk factor of falls are both important concepts when determining their clinical relevance. Implications for Rehabilitation Clinicians should be mindful that the rehabilitation context can present unique falls risk factors, some of which emerge at different times during a patient's rehabilitation. Over the course of a patient's rehabilitation their risk of falling is not linear; therefore, rehabilitation clinicians should undertake periodic falls risk screening. The utility value and statistical significance of falls risk factors are both important aspects to consider when determining their clinical utility.
Generic falls prevention measures are insufficient for preventing falls in the brain injury rehabilitation population. Falls prevention initiatives should target times of high patient activity and situations where there is decreased nursing capacity to observe patients. Rehabilitation clinicians need to be mindful that a patient's risk of falling is not static and in fact, may increase over time.
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