TY - JOUR
T1 - Effect of an Interdisciplinary Stroke Consult Service on the Transition to Postacute Rehabilitation
AU - Venkatachalam, Aardhra M.
AU - Rabroker, Audra
AU - Stone, Suzanne
AU - Manchi, Maunica R.
AU - Sengupta, Samarpita
AU - Ifejika, Nneka L.
N1 - Funding Information:
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).
Publisher Copyright:
© 2022 American Congress of Rehabilitation Medicine
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
KW - Access to care
KW - Patient transfer
KW - Rehabilitation
KW - Skilled nursing facilities
KW - Stroke
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U2 - 10.1016/j.apmr.2022.03.005
DO - 10.1016/j.apmr.2022.03.005
M3 - Article
C2 - 35346660
AN - SCOPUS:85129396454
SN - 0003-9993
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
ER -