So the end result should have been to go back to the original hospital where treated and have them explain what they are doing to prevent these recurrent strokes/readmissions with 100% accuracy. That is what a responsible and excellent hospital would be doing. The board of directors should fire all involved if that isn't occurring. I take no prisoners in trying to identify what needs to be done for solving stroke. You need no medical knowledge to attack this management problem.
Causes of interruption of acute rehabilitation and readmission after stroke
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Abstract
Objective:
The goal of this project was to identify the main causes of unplanned
readmission of stroke patients from inpatient rehabilitation to a
surgical or medical unit.
Background:
Stroke patients admitted to inpatient rehabilitation must meet certain
functional and clinical criteria, therefore, the reasons for readmission
maybe different from those reported for all stroke discharges.
Design/Methods:
Using prospectively maintained database of our CARF-accredited stroke
rehabilitation program, patients with diagnosis of stroke (ischemic
stroke, intracerebral hemorrhage, subarachnoid hemorrhage) who were
discharged to acute care hospitals were identified. We excluded patients
who were readmitted for planned surgery/procedure. Patient
characteristics were extracted from the database and retrospective chart
review.
Results:
We identified 101 stroke patients who had an unplanned readmission (age
64±15 years; 38% female; 72% were white). Of these patients, 73
initially suffered from an ischemic stroke, 24 hemorrhagic stroke, and 4
patients had unknown stroke type. The median (IQR) Functional
Independence Measure score was 55 (38–68). The 3 most common causes of
readmission were recurrent/worsening stroke (n=21), cardiac (n=20), and
infection (n=12). There was no difference between ischemic and
hemorrhagic stroke in LOS 8.9±5.7 vs 9.7±9 days (t test p=0.5), however,
the distribution of readmission reasons was different with DVT/PE more
frequent in hemorrhagic stroke while cardiac reasons more frequent in
ischemic stroke (fisher exact test p=0.02 for both). The median length
of stay second admission was 5 (3–8) days after which only 39 returned
to inpatient rehab, 18 went straight to home, 13 transferred to TCU, 9
went to nursing home, and 17 died.
Conclusions:
Several reasons of transfer from inpatient rehabilitation to acute care
are predictable and preventable especially that these patients are
under direct medical supervision.
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