Causes of interruption of acute rehabilitation and readmission after stroke

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

Amanda Herrmann, Sally Othman, Sarah Jamal, Haitham Hussein

First published April 9, 2019,

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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.