Effect of an Interdisciplinary Stroke Consult Service on the Transition to Post-Acute Rehabilitation

I considered the weekly consults with the doctor and therapists to be totally worthless.  NOTHING SPECIFIC  to get me recovered was ever discussed.

Effect of an Interdisciplinary Stroke Consult Service on the Transition to Post-Acute Rehabilitation

Author links open overlay panelAardhra M.VenkatachalamMPH CCRC¹AudraRabrokerLMSW, ACM, CMAC²SuzanneStoneBSN RN¹Maunica RManchiMD³SamarpitaSenguptaPhD⁴Nneka L.IfejikaMD MPH^356a

https://doi.org/10.1016/j.apmr.2022.03.005Get rights and content

Abstract

Objective

To evaluate the effect of a Physiatry-led Stroke Consult Service on access and time to intensive post-acute rehabilitation.

Design

Prospective observational study

Setting

Urban Joint Commission Comprehensive Stroke Center.

Participants

Adult (> 18 years) acute stroke hospital discharges between 1/1/2018-12/31/2020 (n=1190).

Interventions

Weekday Huddle Rounds were interdisciplinary, which created a pathway to ensure stroke patients received comprehensive rehabilitation care followed by a Virtual Rounding Tool, allowing clinicians to evaluate plan of care facilitation using the Electronic Medical Record.

Main Outcome Measures

Proportion of acute stroke discharges to either home, inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) and onset days to IRF transfer.

Results

During the three-year study period, sociodemographic characteristics, stroke severity at admission and mortality rates did not change significantly.

Acute stroke patient discharges to IRFs increased 5.9%, from 24.2% in 2018 to 30.1% in 2020. 11% of patients were discharged to SNF in 2018, compared to 8.7% in 2020. Proportion of acute stroke patients discharged to home decreased 4.9%, from 49.6% in 2018 to 44.7% (P=0.0325). For ischemic stroke patients, the average onset days to IRF transfer decreased 7.5% between 2018 and 2020, from 8 days to 7.4 days. For hemorrhagic stroke patients, the average onset days decreased 17.5%, from 12 days in 2018 to 9.9 days in 2020. The decrease in onset days were not statistically significant for either stroke type (P=0.3794).

Conclusions

Implementation of Huddle Rounds and a Virtual Rounding Tool by a Physiatry-led Stroke Consult Service significantly increased referrals to IRFs, with a concomitant decrease in referrals to SNFs or directly home. Next steps include validating model efficacy, with the goal of implementation at stroke centers in the United States.(So you didn't measure 100% recovery at all? THE ONLY GOAL IN STROKE!)