Acute rehospitalisation during the first 3 months of in-patient rehabilitation for traumatic brain injury

Abstract

Objective Unplanned re-admission to acute care hospitals during in-patient rehabilitation causes disruption to the rehabilitation program and increases the cost of health care. The aims of the present study were to identify the frequency, reasons and duration of disruption to rehabilitation because of acute re-admissions during the first 3 months of in-patient rehabilitation for traumatic brain injury (TBI) and to investigate the correlation between the duration of acute rehospitalisation and the discharge functional independence measure (FIM) score. Methods A retrospective study was conducted on patients admitted for in-patient rehabilitation following TBI to a rehabilitation hospital in Auckland, New Zealand, between January 2009 and August 2013. Data on duration and reasons for acute rehospitalisation, as well as admission and discharge FIM scores, were obtained from electronic patient records. Pearson correlation was used to evaluate the relationship between the duration of acute rehospitalisation and the discharge FIM score. Results Of the 628 patients admitted for brain injury rehabilitation, 71 (11.3%) required acute rehospitalisation within the first 3 months. The main reasons for acute rehospitalisation were preventable medical causes (43.8%), including urinary tract infections, respiratory tract infections and coronary artery disease. Of the acute re-admissions, 76.6% were within the first month of admission to the rehabilitation centre and 46.6% needed in-patient treatment in the acute care hospital for >5 days. There was a moderately strong negative correlation between the duration of stay in the acute care hospital and the discharge FIM score (r = – 0.412; P = 0.0005). Conclusion A significant number of patients admitted for in-patient rehabilitation following TBI require acute rehospitalisation due to preventable medical causes. Because the duration of acute rehospitalisation has a negative impact on rehabilitation functional gain, preventive measures and surveillance need to be further investigated and optimised. What is known about the topic? The incidence of acute rehospitalisation of patients in the community following brain injury rehabilitation is 20%–25%, with approximately half the re-admissions being for elective reasons, including orthopaedic and reconstructive surgery. What does this paper add? Unplanned acute rehospitalisation during first 3 months of in-patient rehabilitation following TBI is due to preventable causes and results in lower FIM scores on discharge. What are the implications for practitioners? An uninterrupted rehabilitation programme is vital for achieving functional outcomes.