Development of a Pre-admission Screening Checklist to Minimize Acute Discharges from an Inpatient Rehabilitation Facility: A Quality Improvement Initiative

The aim of this study is twofold. Firstly, it attempts to examine the causes of the patient discharge from an inpatient rehabilitation facility (IRF) to an acute care hospital. Secondly, it is intended to develop a Pre-admission Screening Checklist (PSC) and examine its utility in minimizing the acute discharges to improve the care quality.
A retrospective chart review was completed, examining the data from the patients’ medical charts admitted to an inner-city IRF over a 6-month period. A PSC was developed and implemented as a part of admission record review prior to deciding on the patient admission to the IRF. The PSC included information relevant to the patient’s medical condition, rehabilitation potential, and the risk of acute discharge, which was completed over a 4-month period.
According to the results, the rate of acute discharge in the IRF patients was 15.7% in the 6-month period prior to the implementation of the PSC, which included 549 referrals and 86 patients. Additionally, the PSC was applied for 324 referrals over the subsequent 4-month period. Out of the patients that were reviewed using the PSC, 37 cases were acutely discharged from the IRF during their rehabilitation (11.4%). The most common reasons for acute discharge were heart diseases, sepsis, and change in neurological status.
As the findings indicated, the PSC is a useful instrument that can improve the care quality by identifying the patients at the risk of acute discharge before admission to the IRF. The PSC can be a useful adjunct to the efforts made to prevent acute discharges from the IRF by creating a standardized assessment that optimizes the care.