Benchmarking length of stay for inpatient stroke rehabilitation without adversely affecting functional outcomes
Anne Durand, Line D'Amours, Annie Giroux, Maryse Pelletier, Jean Leblond, Carol L. Richards
Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale (Institut de réadaptation en déficience physique de Québec), G1M 2S8 Quebec City, Canada
Objective: To evaluate the effects of introducing the practice of targeting a discharge date for patients admitted to an inpatient stroke rehabilitation unit on process and patient outcomes.
Design: Comparison of retrospective (control group n = 69) and prospective (experimental group n = 60) patients.
Methods: Rehabilitation professionals assessed both groups at admission and discharge using a standard-ized assessment toolkit. Benchmarks for length of rehabilitation stay (LoRS) were introduced based on median severity-specific LoRSs in the control group. The multidisciplinary team documented facilitators and obstacles affecting the prediction of patient benchmark attainment. Categorical variables were compared using a χ2 test with exact probabilities. Ordinal and continuous variables were analysed using rank-based non-parametric analysis of variance. Effect sizes were estimated using a relative treatment effect statistic.
Results: The mean combined length of stay in acute care and rehabilitation beds for the experimental group (82 days) was shorter (p = 0. 0084) than that of the control group (103 days). This 21-day reduction in combined length of stay included a 10-day reduction in the mean time between stroke onset and admission to the stroke rehabilitation unit (p = 0. 000014). Improvements in 6 func-tional and sensorimotor outcomes with rehabilitation were of similar magnitude in both groups, while Functional Independence Measure (FIMTM) efficiency improved (p = 0. 022). The team was 87% successful in predicting which patients were discharged on the LoRS benchmark.
Conclusion: Benchmarking the length of stay in rehabilitation resulted in reduced bed occupation and system costs without adversely affecting functional and sensorimotor patient outcomes.
This study aimed to determine the effects on length of stay and functional recovery of introducing the practice of targeting a date for discharge when patients are admitted to inpatient rehabilitation in the stroke unit. Data for patients who had already completed their rehabilitation were analysed for severity-related target length of stays or benchmarks. In a second group of patients these benchmarks were used to estimate discharge date targets at admission. Both groups received their rehabilitation from the professionals in our stroke unit who assessed their characteristics and functional recovery at the beginning and end of their rehabilitation stay for comparison. Benchmarking was associated with an 11-day mean reduction in length of stay in rehabil-itation and a 10-day mean reduction in the time between stroke onset and admission to rehabil-itation, resulting in fewer bed occupation days (a mean reduction from 103 to 82 days). Functional recovery of the benchmarked group was similar to that of the comparative group. The results show that benchmarking at admission to inpatient rehabilitation was associated with reduced bed occupation and system costs without adversely affecting patient recovery.
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