Length of stay benchmarks for inpatient rehabilitation after stroke

Meyer, Matthew J.; Britt, Eileen; McHale, Heather A; Teasell, Robert

doi:10.3109/09638288.2011.631681

Cited by 19 publications

(29 citation statements)

References 4 publications

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“…The ALOS and RLOS for stroke in our study are similar to those in North America, but shorter than in Japan 13,20,21 . Specifically, the RLOS is relatively short compared to another local stroke rehabilitation cohort and this may represent less complex stroke patients, better initial AFIM scores hence requiring less rehabilitation or it may simply reflect better rehabilitation efficiency 7 .…”

Section: Discussionsupporting

confidence: 74%

Functional Outcomes after Inpatient Rehabilitation in a Prospective Stroke Cohort

Astrid

Silva

et al. 2013

Proceedings of Singapore Healthcare

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Aim: Rehabilitation is proven to improve function following a stroke. The functional outcomes of stroke patients and benefits from rehabilitation are highly variable. We aim to describe functional outcomes and gains following inpatient rehabilitation post-stroke and identify factors associated with improved outcomes. Methods: In this five-years prospective study, data for 1332 consecutive stroke patients admitted to the Singapore General Hospital inpatient rehabilitation unit were charted into a custom-designed rehabilitation database. The primary outcome measure was the Functional Independence Measure (AFIM) and discharge (DFIM). The functional gain was defined as the DFIM-AFIM. Results: The mean age was 64.1±12.5 years, 58.9% were male patients and 78.9% consisted of ischaemic (versus haemorrhagic) strokes. The average rehabilitation length of stay (RLOS) was 18.7±13.9 days and the majority (87.7%) were discharged home. The most common risk factor was hypertension (78.4%) and urinary tract infection (21.2%) was the commonest post-stroke complication. The mean AFIM and DFIM scores were 67.9±23.0 and 83.2±23.5 respectively with a mean functional gain of 15.4±12.3 FIM points. Younger, male, and haemorrhagic stroke patients had better functional outcomes. Multiple regression analysis results revealed that higher DFIM score was associated with higher admission motor and cognitive FIM scores, younger age, male gender, employment at admission, single patients, presence of a caregiver, haemorrhagic stroke, right-sided motor impairments, absence of urinary tract infection or depression, acupunction treatment, and a longer RLOS. The regression model on functional gain was associated with similar independent predictors on DFIM scores except that a higher AFIM was associated with lower functional gains. Conclusion: In this large cohort study, stroke patients make significant functional gains and should be offered rehabilitation to improve outcomes. A comprehensive set of multiple interacting demographic, clinical, cultural, and social factors significanctly impact on stroke functional outcomes after inpatient rehabilitation. The identification of these factors allows optimising rehabilitation for individual patients, and is important for discharge and resource planning.

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Section: Discussionsupporting

confidence: 74%

Functional Outcomes after Inpatient Rehabilitation in a Prospective Stroke Cohort

Astrid

Silva

et al. 2013

Proceedings of Singapore Healthcare

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“…In particular, thanks to the improved clinical outcomes they could face easier rehabilitations, reducing the length of stay of the inpatient rehabilitation that imply huge costs, as underlined by [32].…”

Section: Discussionmentioning

confidence: 99%

Organizational solutions to improve timeliness and effectiveness of the stroke care

et al. 2016

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Background: Saving time means saving neurons in stroke care process. Managerial and organizational solutions that lean the processes should be considered in order to overcome the effects of stroke, which is the second worldwide cause of death. The purpose of the paper is to understand how Health Lean Management (HLM) can be adopted to achieve a more efficient stroke care process. In this peculiar context, efficiency enhancement leads to safety and effectiveness results. For this reason, the investigated projects have been recognized as Lean & Safety (L&S) projects, being HLM projects reporting patient safety improvements. Methods: Due to the peculiarity of the project to investigate, a holistic case study has been conducted in a university hospital of Tuscany region. Thanks to the research framework developed in the literature for L&S projects, data regarding motivations, objectives, organizational and managerial aspects, outcomes, enablers and obstacles of the project have been collected and analysed.Results: A multidisciplinary team, already trained on HLM and supported by the top management, was created and the step-by-step Six Sigma approach was adopted. After a mapping phase, a value stream map was created, Key Performance Indicators were defined and, finally, the Door To Needle (DTN) times and the modified Rankin Scales (mRS) were measured. Thanks to root cause analysis, the identified wastes were analyzed and intervention actions were defined and implemented. They regarded mainly different organizational interventions and they led to a decrease of both DTN times and mRS. Conclusions:The analysed project has demonstrated how it is possible to obtain relevant operational and clinical outcomes through organizational solutions. The analysis of this project, in which pursuing efficiency has led to safety and effectiveness results, has demonstrated how these different performances are linked each other in some peculiar care processes, in which shorter time means more effective and safer care, as in the stroke case. The implementation of L&S projects can improve care processes, providing a contribution to realize a more efficient, effective and safer healthcare system.

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“…Length of stay benchmarks for inpatient rehabilitation after stroke were individualized using the functional status of motor and cognition of patient was studied in Canada (10). Length of study benchmarks were established using 0.75 FIM efficiency, FIM gain divided by length of stay.…”

Section: Discussionmentioning

confidence: 99%

Korean Brain Rehabilitation Registry for Rehabilitation of Persons with Brain Disorders: Annual Report in 2009

et al. 2012

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This first annual report provides a description of patients discharged from rehabilitation facilities in Korea based on secondary data analysis of Korean Brain Rehabilitation Registry V1.0 subscribed in 2009. The analysis included 1,697 records of patients with brain disorders including stroke, traumatic brain injury, brain tumor and other disorders from 24 rehabilitation facilities across Korea. The data comprised 1,380 cases of stroke, 104 cases of brain injury, 55 cases of brain tumor, and 58 cases of other brain diseases. The functional status of each patient was measured using the Korean version of the Modified Barthel Index (KMBI). The average change in the KMBI score was 15.9 for all patients in the inpatient rehabilitation facility. The average length of stay for inpatient rehabilitation was 36.9 days. The transfer rates to other hospitals were high, being 62.4% when all patients were considered. Patients with brain disorders of Korea in 2009 and measurable functional improvement was observed in patients. However, relatively high percentages of patients were not discharged to the community after inpatient rehabilitation. Based on the results of this study, consecutive reports of the status of rehabilitation need to be conducted in order to provide useful information to many practitioners.

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Length of stay benchmarks for inpatient rehabilitation after stroke

Abstract: After a single year of implementation, severity specific benchmarks helped the rehabilitation team reduce LOS while maintaining the same levels of functional gain and achieving the same rate of discharge to the community.

Cited by 19 publications

References 4 publications

Functional Outcomes after Inpatient Rehabilitation in a Prospective Stroke Cohort

Functional Outcomes after Inpatient Rehabilitation in a Prospective Stroke Cohort

Organizational solutions to improve timeliness and effectiveness of the stroke care

Korean Brain Rehabilitation Registry for Rehabilitation of Persons with Brain Disorders: Annual Report in 2009

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