Cherry Tree Close: Achieving Accreditation

Inpatient and Postdischarge Rehabilitation Services Provided in the First Year After Spinal Cord Injury: Findings From the SCIRehab Study

Objective: to determine the structure and organizational features of rehabilitation care for patients on the basis of the regional multidisciplinary health care institution of the third level of medical care.Methods. Research methods: bibliosemantic, statistical, structural-logical analysis and generalization. The materials of the research were the official reporting and accounting forms of medical documentation of the health care institution.Results. Rehabilitation services at the Transcarpathian Regional Clinical Hospital Named After Andriy Novak are focused on providing rehabilitation care mainly to patients with diseases and disorders of the two systems, between which there are fundamental differences in the preferred modes of rehabilitation care (inpatient or outpatient). In March 2022, in the structure of inpatient and outpatient rehabilitation services, the vast majority were services to patients with disorders of the musculoskeletal system and connective tissue (78.4% of the total) and patients with diseases of the nervous system (11.1% of the total). The vast majority (97.5%) of patients with musculoskeletal and connective tissue disorders received outpatient rehabilitation services, while 70.6% of patients with nervous system diseases received inpatient rehabilitation services.Conclusions. Opportunities for the provision of inpatient rehabilitation services on the principle of early rehabilitation in the institution are not fully used. The involvement of patients with other groups of diseases or pathological changes in other organs and systems in rehabilitation care is low.

The purpose of this paper was to profile staffing levels for allied health (AH) professional and support staff in Queensland Health inpatient general rehabilitation services (at a given point-in-time) and compare them against established profession-specific standards and guidelines in order to provide a reference for future workforce planning for these services. A statewide analysis of AH staffing in Queensland Health inpatient general rehabilitation services was undertaken during June-August 2011. Reported full-time equivalent positions (FTE) were compared to several established national and international benchmarks. Patient activity data was used to calculate the average length of stay (ALOS) and Functional Independence Measure (FIM) scores on admission. Sixteen facilities reported 202 FTE for a total of 466 general rehabilitation beds, with a resultant average workforce ratio of 0.43 FTE/bed. While several professional groups within specific services met established benchmarks, the majority failed to reach recommended staffing ratios. More than half the workforce (53%) was entry-level or consolidating clinicians. The FTE/bed ratios were compared against both patient ALOS and FIM scores on admission and showed a poor correlation. Across all included services statewide, there was significant variance in AH staffing levels and diversity in skill mix for inpatient general rehabilitation services.

Quality assessment of mental health rehabilitation services

There has been a resurgence of interest in psychiatric rehabilitation to cater to patients with chronic and complex mental illnesses. This study is aimed at examining patients' characteristics and the prevalence of psychiatric and non-psychiatric comorbidity in a local inpatient rehabilitation service, as well as to investigate the impact of the whole-system approach to rehabilitation on future utilization of mental health services and to analyze the cost-effectiveness and quality of this service. Patients managed over 3 years in a psychiatric rehabilitation inpatient unit were self-controlled; they were retrospectively (pre-rehabilitation) and prospectively (post-rehabilitation) examined for readmission rate, length of stay (LOS), and emergency room (ER) visits. Relevant information was retrieved from Discharge Abstract Database (DAD), Patient Registration System (STAR), and Emergency Department Information System (EDIS). The quality of care in the rehabilitation unit was examined using the Quality Indicator for Rehabilitative Care (QuIRC), and the cost analysis was conducted using data obtained from a single-payer government medical service insurance (MSI) billing system. Of the 185 patients admitted over the study period, 158 were discharged. There was a significant reduction in readmission rate (64% decrease), LOS (6,585 fewer days spent in hospital), and ER presentations (166 fewer visits) (P < 0.0001), respectively. There were substantial subsequent cost savings in the post-rehabilitation year. In the 3-year study, an inpatient psychiatric rehabilitation service in Nova Scotia, Canada, resulted in the successful discharge of most patients with severe and persistent mental illness to more socially inclusive environments. It also reduced their post-rehabilitation mental health service utilization, hence greatly enhancing the effectiveness and efficiency of these services.

BackgroundDespite the success of stroke rehabilitation services, differences in service utilization exist. Some patients with stroke may travel across regions to receive necessary care prescribed by their physician. It is unknown how availability and combinations of post-acute care facilities in local healthcare markets influence use patterns. We present the distribution of skilled nursing, inpatient rehabilitation, and long-term care hospital services across Hospital Service Areas among a national stroke cohort, and we describe drivers of post-acute care service use.MethodsWe extracted data from 2013 to 2014 of a national stroke cohort using Medicare beneficiaries (174,498 total records across 3232 Hospital Service Areas). Patients’ ZIP code of residence was linked to the facility ZIP code where care was received. If the patient did not live in the Hospital Service Area where they received care, they were considered a “traveler”. We performed multivariable logistic regression to regress traveling status on the care combinations available where the patient lived.ResultsAlthough 73.4% of all Hospital Service Areas were skilled nursing-only, only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas; 40.8% of all patients received care in Hospital Service Areas with only inpatient rehabilitation and skilled nursing, which represented only 18.2% of all Hospital Service Areas. Thirty-five percent of patients traveled to a different Hospital Service Area from where they lived. Regarding “travelers,” for those living in a skilled nursing-only Hospital Service Area, 49.9% traveled for care to Hospital Service Areas with only inpatient rehabilitation and skilled nursing. Patients living in skilled nursing-only Hospital Service Areas had more than five times higher odds of traveling compared to those living in Hospital Service Areas with all three facilities.ConclusionsGeographically, the vast majority of Hospital Service Areas in the United States that provided rehabilitation services for stroke survivors were skilled nursing-only. However, only about one-third lived in skilled nursing-only Hospital Service Areas; over 35% traveled to receive care. Geographic variation exists in post-acute care; this study provides a foundation to better quantify its drivers. This study presents previously undescribed drivers of variation in post-acute care service utilization among Medicare beneficiaries—the “traveler effect”.

Current health policy assumes better quality services lead to better outcomes. To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes. Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes. A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life. Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.

Summary Background: Mental health rehabilitation services focus on people with severe and complex problems that impair their function and make them potentially vulnerable to exploitation and abuse. They require longer term treatment and support from a range of inpatient and community services that hold therapeutic optimism and adopt a recovery orientation. Aims: In recent years, specific tools and processes have been developed to facilitate assessment of the quality of care in services that provide rehabilitation. These include the built environments where people receive support, the therapeutic culture of these facilities, the treatments and interventions provided, the degree to which autonomy and community engagement are promoted, and the process for safeguarding human rights. Results: When local rehabilitation services are available, most people are able to be successfully discharged to the community, achieving greater independence incrementally. The quality of inpatient rehabilitation services has been shown to be positively associated with service users’ autonomy, the main aim of rehabilitation, with the most important aspect being the recovery orientation of the service.

Disparities in Multi-Disciplinary Rehabilitation after Cerebral Hemispherectomy: A Patient-Centered Report from the Global Pediatric Epilepsy Surgery Registry

BackgroundThis study focuses on people with complex and severe mental health problems who require inpatient rehabilitation. The majority have a diagnosis of schizophrenia whose recovery has been delayed due to non-response to first-line treatments, cognitive impairment, negative symptoms and co-existing problems such as substance misuse. These problems contribute to major impairments in social and everyday functioning necessitating lengthy admissions and high support needs on discharge to the community. Engagement in structured activities reduces negative symptoms of psychosis and may lead to improvement in function, but no trials have been conducted to test the efficacy of interventions that aim to achieve this.Methods/designThis study aims to investigate the clinical and cost-effectiveness of a staff training intervention to increase service users’ engagement in activities. This is a single-blind, two-arm cluster randomised controlled trial involving 40 inpatient mental health rehabilitation units across England. Units are randomised on an equal basis to receive either standard care or a “hands-on”, manualised staff training programme comprising three distinct phases (predisposing, enabling and reinforcing) delivered by a small team of psychiatrists, occupational therapists, service users and activity workers. The primary outcome is service user engagement in activities 12 months after randomisation, assessed using a standardised measure. Secondary outcomes include social functioning and costs and cost-effectiveness of care.DiscussionThe study will provide much needed evidence for a practical staff training intervention that has potential to improve service user functioning, reducing the need for hospital treatment and supporting successful community discharge. The trial is registered with Current Controlled Trials (Ref ISRCTN25898179).

Inpatient rehabilitation plays a pivotal role in the stroke recovery continuum. We have previously shown how rehabilitation clinical guidelines and health care design guidelines may not fully align to support recovery needs. Building on our previous work describing the current stroke inpatient rehabilitation service, we aimed to articulate and propose recommendations for an optimal inpatient service through the integration of stakeholder feedback, clinical guidelines, and health care design principles. We used value-focused thinking, living-lab, and codesign principles to evaluate a re-imagined stroke rehabilitation service. Participants reviewed 21 care process activity blocks derived from our previous work, with proposed changes to the admission, discharge processes, and weekday routines (morning, afternoon, and evening) of a typical Australian inpatient stroke service. Participants used an agreement scale to rate the proposed changes against predefined objectives focusing on safety, efficiency, emotional well-being, and opportunities for practice, rest, and autonomy. The reimagined stroke service was reviewed and iteratively refined through further validation sessions with selected participants. Twenty-six stakeholders participated in our evaluation, including stroke survivors, caregivers, clinicians, researchers, and health care facility designers and planners. Nineteen activity blocks were rated, generating 152 individual votes and 15 recommendations for service improvement. Overall, the agreement rate across all proposed changes was 76%. The highest agreement was observed in the evening (100%) and admission (81%) blocks, with strong endorsement for improved information delivery and environmental flexibility. Lower agreement was noted for discharge (61%), reflecting the complexity and varied perspectives on transition planning. Validation with 7 participants confirmed the relevance and feasibility of most proposed changes, especially those that support personalization, autonomy, and early engagement. Stakeholder-informed redesign of stroke rehabilitation services can enhance alignment between clinical processes and environmental enablers. These findings offer a practical foundation for codesigned models of care that are both evidence-based and experientially grounded.

Trends in outpatient rehabilitation use for stroke survivors

Purpose:To provide an outline of the timeline from acute care admission to inpatient rehabilitation facility discharge and describe the functional progress and tolerance of 2 individuals who were hospitalized but not intubated because of COVID-19.Method:Retrospective data were collected from the electronic medical record to describe the rehabilitation course of the first 2 consecutive patients admitted to the rehabilitation facility who were recovering from COVID-19. Both patients were octogenarian men who experienced functional decline while hospitalized for symptoms of COVID-19 and were recommended for further inpatient rehabilitation services. Progress during inpatient rehabilitation was tracked using the following outcome measures: Centers for Medicare & Medicaid Services Quality Indicators (QI), 6-Minute Walk Test, 10-Meter Walk Test, Timed Up and Go, and Berg Balance Scale.Results:Patient 1 had an 18-day acute care stay, a 13-day inpatient rehabilitation facility stay, and was discharged to home. Patient 2 had an interrupted 19-day acute care stay, a 15-day inpatient rehabilitation facility stay, and was discharged to a skilled nursing facility. Patient 1 improved 160.98 m in the 6-Minute Walk Test, 0.08 m/s in self-selected walking speed, and 85 points in the total Quality Indicators score. Patient 2 improved 115.22 m in the 6-Minute Walk Test, 0.14 m/s in self-selected walking speed, and 39 points in the total Quality Indicators score.Conclusion:The patients made clinically meaningful improvements in each outcome measure during their length of stay for inpatient rehabilitation. This reveals the positive rehabilitation potential of 2 older adult patients with COVID-19 and demonstrates the patients' ability to maintain inpatient rehabilitation facility level of activity. With individualized care and discharge planning, similar patients may make significant gains in function despite advanced age and comorbid conditions.

Purpose: To evaluate the effectiveness of the introduction of a Saturday inpatient rehabilitation service in improving patient outcomes and facilitating hospital access and flow. Methods: A quasi-experimental study with a historical comparison group is presented. Data were evaluated for the 477 patients admitted and discharged in the 6 months following the implementation (October 2012–March 2013) of the service and 499 patients in the historical control group (April 2012–September 2012). Results: Prior to the introduction of the service median number of patients admitted on a Saturday was 0 (range 0–3), post-implementation the median number of patients admitted on a Saturday increased to 2 (range 0–5), this difference was statistically significant (Z = −3.61, p < 0.001). Median regression modelling demonstrated that, after adjusting for admission Functional Independence (FIM) score, gender, length of stay (LOS) and age, there was a small but significant increase in discharge FIM scores (median increase 2.28, p = 0.027) for those patients admitted in the post-implementation phase. There was no such effect of the service on LOS. Conclusions: The implementation of the Saturday inpatient rehabilitation service was associated with improved patient outcomes and supported an increase in patient flow throughout the organization as evidenced by an increased number of Saturday patient admissions.Implications for RehabilitationInpatient rehabilitation services do not operate in isolation; they are a critical link in the healthcare continuum.There is a mounting body of evidence that the introduction of weekend rehabilitation services has a positive impact on patient outcomes.To maximize health outcomes, access to critical services and patient flow, organizations and staff need to move away from the long-standing 5-day/week inpatient rehabilitation model and start transitioning to a model that incorporates weekend therapy services.

Introduction: The COVID-19 pandemic has posed great challenges in inpatient rehabilitation services, not only to implement the preventative measures to avoid the spreading of the virus in a highly interactive, multidisciplinary setting but also to create a rehabilitation pathway for post-COVID-19 patients. The aim of this retrospective study was to describe the role of a digital and artificial intelligence platform (DAIP) in facilitating the implementation of changes in a rehabilitation service during the COVID-19 pandemic.Materials and Methods: We gathered qualitative and quantitative descriptors of the DAIP, including measures to assess its efficiency in scheduling therapy sessions, and staff satisfaction using two simple numeric rating scales and the System Usability Scale. We describe how the volume of activity and the quality of care of our rehabilitation service have changed when the DAIP was implemented by comparing the pre-COVID-19 and the pandemic periods for patients' [sex, age, co-morbidities, diagnosis, and Functional Independence Measure (FIM) gain] and service's (bed occupancy, patients' length of stay, and staff capacity) characteristics.Results: Bed occupancy and the impact of rehabilitation on patients' outcome remained stable between the two periods. The DAIP provided a qualitative support for goal setting from remote; 95% of the planned sessions were delivered; the time for scheduling and registering sessions dropped by 50%. Staff satisfaction was about 70% for the easiness and 60% for the usefulness, and the mean “usability” score was close to the cut off for sufficient usability (mean score 65 where 68 is the cut off).Conclusion: By applying the DAIP to rehabilitation treatment, it was shown that the management of rehabilitation can be efficiently performed even in the COVID-19 pandemic. Staff satisfaction reflected a good acceptance of the changes considering the turbulent changes and the stress burden occurring at the time of the pandemic.