Reducing the length of stay for acute hospital patients needing admission into inpatient rehabilitation: a multicentre study of process barriers

Background Patient flow is a major problem in hospitals. Delays in accessing inpatient rehabilitation have not been well studied. Aims Measure the time taken for key processes in the patient journey from acute hospital admission through to inpatient rehabilitation admission in order to identify opportunities for improvement. Methods Retrospective open cohort study. All patients admitted over 8‐ and 10‐month periods during 2008 into two inpatient rehabilitation units in Melbourne, Australia. Main outcome measures were the duration of the following key processes: acute hospital admission until referral for rehabilitation, referral until assessment by the rehabilitation service, assessment until deemed ready for transfer to rehabilitation, ready for transfer until rehabilitation admission. Results Three hundred and sixty patients were in the study sample (females = 186; 51.7%); mean age = 58.4 (standard deviation = 15.0) years. There was a median of 7 (interquartile range [IQR] 4–13) days from acute hospital admission till referral for rehabilitation, a median of 1 (IQR 0–1) day from referral till assessment, a median of 0 (IQR 0–2) days from assessment till deemed ready for transfer and a median of 1 (IQR 0–3) day from ready till admission into rehabilitation. Overall, patients spent 12.0% (804/6682) of their acute hospital admission waiting for a rehabilitation bed. Conclusions There are opportunities to improve the efficiency of key processes in the acute hospital journey for patients subsequently admitted to inpatient rehabilitation; in particular, reducing the time from acute hospital admission till referral for rehabilitation and from being deemed ready for transfer to rehabilitation till admission.