126 - Liaison Pre-Admission Checklist, First Line Against Unstable Admissions

To reduce Acute Care Transfer (ACT) rate from a standalone Inpatient Rehabilitation Facility (IRF) by 25% in the first 96 hrs over 3 months.

Design:

QI intervention: A day-of-admission checklist was created for rehab liaisons as a “pause” prior to admission. It includes a chart review and in-person observations. The chart review evaluates several factors to assess a patient’s stability for rehabilitation: use of intravenous blood pressure or pain medications in the 24 hours prior, recent hemoglobin or white blood cell count derangements, and acceptable vital signs. The in-person screen ensures the patient is amenable to attending IRF, have fair pain control, stable mental status, and no new symptoms not yet addressed by their medical team. If any item is not checked off, the liaison reviews the case with the IRF medical director.

QI implementation: This checklist was rolled out after a virtual meeting with all liaisons to describe the new process. QI metrics: ACT rates were obtained by reviewing discharge data in the 3 months prior to the checklist implementation and 3 months following.

Results:

A 3.7% ACT rate within 96 hours in the pre-intervention period increased to 3.8% post-intervention. However, the overall ACT rate decreased from 12.9% pre-intervention to 11.6% post-intervention.

Conclusions: A rehab liaison checklist was implemented as a screening tool to identify patients who are not medically ready for IRF. The checklist reduced the overall ACT rate, however did not show a reduction in ACTs in the first 96 hrs. This suggests that the tool may be helpful for reducing ACTs, but may not be capable of capturing unstable patients at the beginning of their rehabilitation course. Further efforts to ensure compliance with the checklist, and data analysis over a longer time frame will be important to establish the impact of this QI intervention.