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Rehab Hospitals Retooling

Joe Cantlupe, for HealthLeaders Media, April 25, 2011
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Because most quality benchmarks have not been commonly measured in patient rehabilitation, such facilities have lagged behind the acute care hospital sector, Harrington says. Historically, rehabilitation hospitals’ work was measured only against acute care–based systems, but there have been different issues involved, so it’s like comparing “apples and oranges,” Harrington says.

When Carolinas Rehabilitation staff suggested collaborating with other hospitals, it was initially greeted with resistance, she says. “Literally, a group of administrators were sitting around one day, and someone said, ‘Let’s call up another rehab hospital and see if they could send us their data,’” she says. Initially, hospital leaders—especially the legal staff—“nearly fell off their chairs” at the prospect, she says. Eventually, however, a plan was developed with other cooperating facilities, she says.

“We were struggling internally as a hospital to see how well we were doing; we wanted to provide the safest care possible,” she says.

So, Harrington says, in July 2010, Carolinas Rehabilitation formed a patient safety organization in accordance with Agency for Healthcare Research and Quality guidelines. According to Harrington, the PSO allows EQUADR to offer an environment where healthcare organizations can collect and analyze data to reduce risk associated with patient care.

Quarterly conference calls are held among the participating hospitals after the aggregate data is released, in order to share best practices and discuss challenges, Harrington says. “We have a call about a week after the quarterly meeting with data reports sent back to each hospital, and we all have a chance to review the aggregate data,” she says.

Success Key No. 2: Reducing falls

A significant problem area for any hospital is the risk of falls for patients, and officials at rehabilitation hospitals say the situation is of particular concern in their facilities because they generally encourage people to have more mobility over a longer period of time than acute care hospitals do.

During a one-year period, Carolinas Rehabilitation reduced falls by 20%, Harrington says. “That’s a significant drop for us. It has been a major issue for a while, [but] we didn’t know where we stood.”

Falls represent an area of patient safety that rehabilitation hospitals should measure against themselves, not acute care facilities, she says. The nature of inpatient rehabilitation care and the needs of those patients “dictate you are not going to have the same outcomes,” she says.

While falls among hospital inpatients generally range from 2.3 to 7 falls per 1,000 patients in acute care facilities, they are more common in rehabilitation facilities, and the risk of fall is very high among stroke patients, according to the National Quality Forum and Maryland Hospital Association Quality Indicator Project. Fall rates at rehab hospitals are estimated at 8 to 19.9 per 1,000 patients under the Morse Fall Scale, a program adopted by the VA hospital system and other healthcare facilities across the country to measure patient falls.

Comparing fall rates among different institutions is difficult because of varying definitions of what constitutes a fall, methods to report data, and differences in settings and patient populations, according to the Barnes-Jewish Hospital and the Washington University School of Medicine in St. Louis, which have studied falls. About 30% of inpatient falls result in injury, according to researchers.

Still, Harrington says that Carolinas Rehabilitation’s fall-reduction work could be attributed “mostly to a change in culture.” The hospital administration adopted fall reduction as a top priority for 2010, and “that was communicated to frontline staff through multiple channels.”

The hospital achieved its fall-reduction goals after an interdisciplinary team, led by the patient safety coordinator, formed a falls committee that analyzed falls data and recommended interventions that were piloted throughout the hospital.

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