Session Information
Date: Saturday, November 16, 2019
Session Title: Quality Improvement Case and Research Report
Session Time: 11:15am-12:45pm
Location: Research Hub - Kiosk 8
Disclosures: Brittni Micham, MD: Nothing to disclose
Objective: Reduce acute readmissions from inpatient rehabilitation (IPR).
Design: Chart review was completed on patients who transferred out of IPR within 7 days of admission and data were analyzed for trends. Education was provided to staff and a preadmission screening checklist was created. The readmission rate was then followed post-intervention.
Setting: IPR hospital
Participants: Acute readmissions
Interventions: Staff education and preadmission screening
Main Outcome Measures: Acute readmission rate
Results: In 2017, an IPR hospital had 1,367 admissions and 84 unplanned transfers back to acute care within 7 days of arrival (6.14%). Among these 84 patients, leading IPR admission diagnoses were stroke (57%), spinal cord injury (11%) and hip or pelvic fracture (6%). In the 48 hours preceding arrival to IPR, 35% had documented leukocytosis above WBC 12 and 32% were tachycardic with heart rate greater than 100 bpm. The top three acute readmission diagnoses were respiratory distress (31%), new or evolving stroke (16%) and gastrointestinal bleed (12%). The category of respiratory distress included aspiration pneumonia, which accounted for 11% of total transferred patients. The most common diagnoses made on acute after transfer off IPR were pneumonia (20%), DVT (19%), sepsis (19%), UTI (14%), pulmonary embolism (12%) and wound complication (12%). Education was provided to physicians and staff on the above findings to increase awareness. A preadmission checklist was created to screen for fever, tachycardia, leukocytosis, increasing oxygen requirement, severe anemia, dysphagia and any recent treatment by a rapid response team. Case managers coordinating admissions to IPR were given the checklist and began notifying rehabilitation physicians if a potential admission flagged any items. In the 6 months following intervention, the same IPR hospital had 495 admission and only 23 acute readmissions within 7 days of arrival (4.65%): a decrease in the average readmission rate by 24%.
Conclusions: This easily implemented intervention resulted in a precipitous decrease in acute transfers from IPR.
Level of Evidence: Level V
To cite this abstract in AMA style:
Micham B, Henderson M, D'Angelo A, Lloyd A, Moreta M, Desmarais LM, Gabet J, Navlani R, Deluca K. Reducing Readmissions to Acute Care from Inpatient Rehabilitation: Identifying Trends and Implementing Intervention [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/reducing-readmissions-to-acute-care-from-inpatient-rehabilitation-identifying-trends-and-implementing-intervention/. Accessed May 18, 2025.« Back to AAPM&R Annual Assembly 2019
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/reducing-readmissions-to-acute-care-from-inpatient-rehabilitation-identifying-trends-and-implementing-intervention/