Objectives: Minimize hospital disposition barriers & Post acute care rehabilitation delays in Functionally impaired Patients PROBLEM: Patients with functional impairments appropriate for inpatient rehabilitation facility (IPR) for post acute care rehab are in fact not getting discharged to IPR leading to suboptimal care dispositions, outcomes & rehospitalizations
Design: Root Cause Analysis methodology: • Insurance barriers: Delays in communications (ie faxing), re-evaluations requests, subsequent Insurance denials despite Peer reviews • Institution barriers: COVID negative test requirements by facilities 24-72 hrs before discharge. Facility Assignments: patients have location preferences, bed availability, acceptance or rejection of patient by facility • Individual barriers: Patient-family education, decision making process • PT/OT/SLP/ PM&R Consult timing delays & suboptimal care coordination
Results: Data Analysis: Overall in 2020, 476 out of 845 patients (56.33%) were recommend to IPR 208 out of 476 patients recommended (43.70%) got actually discharged to IPR Root Cause Analysis: • Insurance barriers: Delays in communications (ie faxing), re-evaluations requests, subsequent Insurance denials despite Peer reviews • Institution barriers: COVID negative test requirements by facilities 24-72 hrs before discharge. Facility Assignments: patients have location preferences, bed availability, acceptance or rejection of patient by facility • Individual barriers: Patient-family education, decision making process • PT/OT/SLP/ PM&R Consult timing delays & suboptimal care coordination
Conclusions: Early functional impairment evaluation & appropriate clinical documentation by rehabilitation therapists and PM&R Physiatrists remains critical • Patient and Caregiver Support: Formal IPR discussion for patient and family education requiring standardized documentation by case management/Care coordination teams • Data analysis indicates 43.70% of IPR appropriate patients got actually admitted to IPR • IPR disposition is multifactorial complex process requiring teamwork optimization and streamlining of hospital workflow. • Critical to accurately identify & quantify various disposition barriers to the next appropriate level of care
