Assessing the Effect of Late Admissions on Rehabilitation Outcomes

Background: According to a prior study by Faulk et al., patients who were admitted to an acute inpatient rehabilitation facility after 7PM were found to have a higher percentage of return to the acute care hospital (RTACH) compared to patients admitted prior to 7PM. The study also found that the highest percentage of RTACH was seen among patients who were admitted between the timeframe of 11 to 11:59PM. A similar retrospective chart review study by Foster et al. found that the time of day or day of week of a patient’s admission to an acute rehabilitation facility did not predict the likelihood of an unplanned transfer to an acute care hospital. However, the researchers found that patients had variable unplanned transfer rates based on their admitting diagnoses. At KWO, patients with varying diagnoses of medical complexities are admitted to the facility at various times throughout the day despite the lack of availability of the primary physiatry teams and consulting internal medicine service after certain hours.

Aim Statement: We chose to investigate how the timing of admission and the complexity of diagnoses affects rehabilitation complications, including unplanned transfers, falls, urgent bloodwork and/or imaging, and missed therapy sessions, at KWO.

Methods: Retrospective chart review of all patients admitted to KWO between 2/1/23 and 2/14/23 was performed. Any readmitted patients were excluded. Patients were categorized by time of admission (divided by hour) and diagnosis (TBI, nTBI, CVA, Seizure, SCI, Orthopedic, Amputee, General, or Other). Patient charts were then reviewed to identify specific primary drivers that may impact rehabilitation complications including: 1) unplanned transfers to acute care hospital, 2) falls within the first 48 hours of admission, 3) required urgent blood work and/or imaging, and 4) missed therapy sessions.

Results: A total of 109 patient charts were reviewed. 41 of the 109 patients were admitted between 8AM and 5PM. The highest percentage of patients (17.4%) were admitted during the 6PM to 7PM timeframe. Four patients (3.7%) experienced unplanned transfers within their first 24 hours of admission and all four patients were admitted between 1PM and 3PM. Three (2.8%) patients experienced falls within their first 24 hours of admission and one of those patients was admitted after 5PM. 14 patients experienced missed therapy sessions and 46% of those patients were admitted after 5PM. Lastly, only one patient required urgent labs within 24 hours of admission and the patient was admitted prior to 5PM.

Conclusion: There was no significant correlation found between patient admissions after 5PM and adverse rehabilitation complications within the selected patient sample. However, late patient admissions continue to be a source of stress and concern for admitting residents at KWO. Next steps for this project include a resident survey to subjective assess resident sentiments regarding late admissions.