A model for predicting delay in discharge of stroke patients

Skilled nursing facility functional rehabilitation outcome: Analyses of stroke admissions

Introduction:

The purpose of this study was to facilitate programme evaluation in skilled nursing facilities (SNF) using activities of daily living to quantify productivity, to provide consistency in data management and to establish a stroke inpatient rehabilitation outcome benchmark.

Method:

A documentation system of ADL was designed and integrated into the electronic medical records; a prerecorded webinar was developed for training in the administration of the Modified Barthel Index (MBI); and a pilot study on 234 patients from 13 centres was completed to ensure the system was in place. SNF rehabilitation outcomes were determined from the changeover time in admission to discharge MBI scores in 2 041 stroke patients.

Results:

The mean age was 75.89 ± 13.69 years. The mean length of inpatient stay was 31.15 ± 21.82 days. Rehabilitation efficiency was 1.09 ± 1.1 points improvement in the MBI score per day. The degree of rehabilitation intervention effectiveness was 48.03 ± 31.90%. The rate of change indicates superior outcome.

Future directions:

The MBI is now being introduced across 37 States in the US and outcomes will be evaluated in approximately 26 000 persons to establish performance standards that SNF rehabilitation teams would expect for routine diagnostic related groups.

Length of stay in an Australian stroke rehabilitation unit: a pilot study

Aims

Length of stay (LOS) is an important consideration in rehabilitation, and it can be adversely affected by delayed discharge. The purpose of this prospective study was to document LOS, frequency of discharge delay, reasons for discharge delay and its impact on LOS.

Methods

Ninety-eight inpatients in a stroke rehabilitation unit were included in the study.

Findings

Sixty (61%) patients had a LOS that exceeded the Australasian Rehabilitation Outcomes Centre (AROC) benchmark LOS according to the Australian National Sub-acute and Non-acute Patient classification system. Twenty-five (26%) patients had delayed discharge resulting in a total delay of 886 days, with most of these related to delays in the provision of community services. When patients with discharge delay were factored out of analyses, LOS was still longer than AROC benchmark figures for 39 (57%) of the 69 patients without discharge delay.

Conclusions

The LOSs of the majority of patients included in this study were longer than the AROC benchmark figures, even when patients with discharge delay were factored out. Initiatives to address this problem include the implementation of a proactive computerized tool that will provide target LOSs and enable reasons for excessive LOS to be more closely examined.