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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 25, 2022
Accepted:
March 20,
2022
Received in revised form:
March 8,
2022
Received:
August 9,
2021
Footnotes
Dr Ifejika's current work is supported by the University of Texas Southwestern/Texas Health, Resources Clinical Scholar Award (#4). Dr Ifejika's previous work was supported by the Center for Clinical and Translational Sciences at the McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), funded by NIH/National Center for Advancing Translational Sciences Clinical and Translational Award UL1 TR000371 and KL2 TR000370. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the NIH. Dr Ifejika's preliminary work was supported by the NIH/National Institute of Neurological Disorders and Stroke Diversity Supplement to P50 NS 044227, the University of Texas Specialized Program of Translational Research in Acute Stroke (SPOTRIAS).
Disclosures: none
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
