Disclosures: Justin L. Weppner, DO: Nothing to disclose

Objective: We studied patient outcomes among severe brain injury survivors followed in the acute setting by a Brain Injury Medicine (BIM) continuity consultation service.

Design: Case-control

Setting: Academic medical center

Participants: 238 patients were admitted to our brain injury rehabilitation unit for their initial inpatient rehabilitation stay over a 2-year period. Of these, 73 were followed by the BIM continuity service while on acute care; the remainder served as controls.

Interventions: Patients received usual medical care at a single acute care facility and were admitted to a single inpatient rehabilitation (IPR) facility. Treated at the same facilities, those followed by the BIM consult service received additional acute care physiatry evaluations, screening for medical complications, and management of sleep/wake cycles, neurostimulation, paroxysmal sympathetic hyperactivity, agitation, electrophysiology, bracing, spasticity, pain, transitions of care, and family education/prognosis.

Main Outcome Measures: 1. Emergence for minimally conscious state; 2. Acute length of stay; 3. Rehabilitation length of stay; 4. Unplanned transfers to acute.

Results: No significant demographic or clinical differences were noted between groups. BIM consult cases were substantially more complex, had a greater number of comorbidities, and had a higher Case Mix Index than controls. Despite this, BIM cases spent 6 fewer days on acute care. BIM rehabilitation lengths of stay were 5.2 days longer than controls but when unplanned transfers were controlled for there was no statistically differences in length of stay. Among disorders of consciousness patients, JFK Coma Recovery Scale score gains were similar, initial JFK scores for BIM Consult patients were higher, such that more emerged from a minimally conscious state during IPR versus controls.

Conclusions: Early physiatric interventions by the BIM continuity service had a significant impact on quality of care facilitating and preparing patients for early admission to rehabilitation, decreasing unplanned transfers, and increasing the likelihood of emerging from a minimally conscious state at our institution.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/more-than-just-dispo-effects-of-an-acute-care-brain-injury-medicine-continuity-service-on-healthcare-utilization-and-rehabilitation-outcomes/