A quality improvement initiative for improving appropriateness of referrals from a cancer center to subacute rehabilitation

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.

Keywords: Palliative care; goals of care; physical therapy; quality improvement; subacute rehabilitation.