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Effect of an Interdisciplinary Stroke Consult Service on the Transition to Postacute Rehabilitation

Published:March 25, 2022DOI:https://doi.org/10.1016/j.apmr.2022.03.005

      Abstract

      Objective

      To evaluate the effect of a physiatry-led stroke consult service on access and time to intensive postacute rehabilitation.

      Design

      Prospective observational study.

      Setting

      Urban Joint Commission Comprehensive Stroke Center.

      Participants

      Adult (older than 18 years) acute stroke hospital discharges between January 1, 2018, and December 31, 2020 (N=1190).

      Interventions

      Weekday huddle rounds were interdisciplinary, which created a pathway to ensure patients with stroke received comprehensive rehabilitation care followed by a virtual rounding tool, allowing clinicians to evaluate plan of care facilitation using the electronic medical record.

      Main Outcome Measures

      Proportion of acute stroke discharges to home, inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF) and onset days to IRF transfer.

      Results

      During the 3-year study period, sociodemographic characteristics, stroke severity at admission, and mortality rates did not change significantly.
      Discharges of patients with acute stroke patient to IRFs increased 5.9%, from 24.2% in 2018 to 30.1% in 2020. A total of 11% of patients were discharged to SNF in 2018 compared with 8.7% in 2020. Proportion of patients with acute stroke discharged to home decreased 4.9%, from 49.6% in 2018 to 44.7% (P=.0325). For patients with ischemic stroke, the average onset days to IRF transfer decreased 7.5% between 2018 and 2020, from 8 days to 7.4 days. For patients with hemorrhagic stroke, the average onset days decreased 17.5%, from 12 days in 2018 to 9.9 days in 2020. The decrease in onset days were not statistically significant for either stroke type (P=.3794).

      Conclusions

      Implementation of huddle rounds and a virtual rounding tool by a physiatry-led stroke consult service significantly increased referrals to IRFs, with a concomitant decrease in referrals to SNFs or directly home. Next steps include validating model efficacy, with the goal of implementation at stroke centers in the United States.

      Keywords

      List of abbreviations:

      CME (continuing medical education), IRF (inpatient rehabilitation facility), NIHSS (National Institutes of Health Stroke Scale), PM&R (physical medicine and rehabilitation), SNF (skilled nursing facility), UTSW (University of Texas Southwestern Medical Center)
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