Factors associated with patient selection for inpatient rehabilitation: an audit of decision-making in the rehabilitation assessment

Abstract

Background:

Assessment of patients for their potential to participate and benefit from inpatient rehabilitation forms an integral component of the practice of rehabilitation medicine. There is limited information in the current literature to guide or standardize the decision-making in rehabilitation assessment.

Setting:

Inpatient rehabilitation unit within a major tertiary public hospital in metropolitan Melbourne, Australia.

Objective:

To determine which information routinely collected during the rehabilitation assessment is associated with the likelihood of a patient being accepted for inpatient rehabilitation.

Design:

A retrospective audit of consecutive rehabilitation assessments carried out over a 4-month period.

Methods:

Multivariable association between patient clinical and demographic characteristics and the likelihood of being accepted for inpatient rehabilitation was assessed for 219 acute inpatients referred to the inpatient rehabilitation unit.

Results:

Of the 219 patients, 74.9% were accepted for inpatient rehabilitation. There were statistically significant deficits in cognition, continence, personal care, and mobility at the time of patients’ assessment for inpatient rehabilitation. Patients’ premorbid level of independence with personal activities of daily living (PADLs) (P = 0.006) and continence (P = 0.04), as well as “at the time of assessment” need for assistance with PADLs (P < 0.001), mobility (P = 0.004), incontinence (P = 0.01), and impaired cognition (P < 0.001), were associated with the likelihood of being accepted for inpatient rehabilitation.

Conclusion:

Premorbid dependence with PADLs and current impaired cognition as well as incontinence reduce the likelihood of patient selection, while present dependence with PADLs and mobility increase the likelihood of patient admission. Our findings provide researchers, clinicians, and health managers with empirical evidence regarding the process of patient selection for inpatient rehabilitation.

Keywords::

• rehabilitation
• disability evaluation
• rehabilitation centers
• medical decision-making