A Quality Improvement Initiative for Improving Appropriateness of Referrals From a Cancer Center to Subacute Rehabilitation
Journal of Pain and Symptom Management
Volume 48, Issue 1 , Pages 127-131, July 2014
Abstract
Background
Subacute
rehabilitation may not be appropriate for many patients with advanced
cancer. We evaluated outcomes of cancer center inpatients transferred to
subacute rehabilitation, implemented a multidisciplinary intervention
to improve appropriateness of referrals, and evaluated its potential
impact.
Measures
Percentage of patients who returned for
further anticancer treatment after subacute rehabilitation
(preintervention) and percentage of patients who were referred and
transferred to subacute rehabilitation (pre and post).
Intervention
Stakeholder
engagement; feedback about outcomes to faculty and staff; increased
communication between therapy, social work, nursing, and physicians
about therapy referrals; and goals of care at daily prerounds meeting.
Outcomes
Potential
reduction in subacute rehabilitation referrals and transfers. Intensive
intervention was difficult to maintain, but team is continuing efforts
at improved communication.
Conclusions/Lessons Learned
Intervention
may have improved outcomes short-term but was complicated and difficult
to maintain. Addressing appropriateness of subacute rehabilitation
referrals can occur within a multidisciplinary approach to improving
communication about goals of care for patients with advanced disease.
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