Prospective study of barriers to discharge from a spinal cord injury rehabilitation unit.

Abstract

STUDY DESIGN: Prospective open cohort case series of consecutive patients admitted with spinal cord damage to a spinal rehabilitation unit (SRU) between 1 January 2008 and 31 July 2013. OBJECTIVES: Measure the prevalence of barriers to discharge, their reasons and resulting additional unnecessary days in hospital. SETTING: SRU, Victoria, Australia. METHODS: Consecutive SRU admissions had prospective documentation of key clinical and demographic characteristics, the occurrence of any discharge barrier, the cause(s) and duration of unnecessary hospitalisation. RESULTS: There were 235 patients in the study; 138 (58.7%) were male and the median age was 63 years. Eighty-six (36.6%) patients had a discharge barrier. The most common reasons for a discharge barrier were: waiting for approval for long-term and supported care or services, residential care, home modifications, family deliberations regarding discharge planning and the provision of equipment necessary for discharge. The reasons accounting for the greatest number of additional hospital days were: home modifications, residential care, equipment necessary for discharge, waiting for approval for long-term and supported care or services and accommodation for people unable to return to their previous residence without readily available alternatives. Over the study period 17.5% (3176/18 184) of all bed-days were occupied by patients deemed to be clinically ready for discharge from the SRU but who had a discharge barrier. CONCLUSIONS: Barriers to discharge from rehabilitation for patients with spinal cord damage are common, substantial, and represent an important opportunity for health systems improvement.