Implementation and Outcomes of an Early Rehabilitation Program in a Tertiary Emergency and Critical Care Center: A Single-Center Historical Cohort Study

Early rehabilitation may reduce the likelihood of long-term disability after critical illness, but in high-turnover emergency and critical care settings, benefits other than improved survival may appear at discharge. This retrospective historical cohort study assessed the impact of a standardized rehabilitation system initiated within 24 h of hospital arrival on inpatient and discharge outcomes. The study included consecutive intensive care unit admissions between 2011 and 2023 and compared periods before and after 1 April 2022 when the system was introduced. Outcomes included in-hospital mortality, frequency of a favorable discharge outcome (Glasgow Outcome Scale score indicating good recovery or moderate disability), rate of transfer to a rehabilitation hospital, and length of hospital stay. Between-period differences were adjusted using propensity-score overlap weighting. Among 20,252 patients, adjusted analyses showed no significant differences in in-hospital mortality (odds ratio [OR] 1.17, 95% confidence interval [CI] 0.81-1.69) or length of stay (mean difference -0.12 days, 95% CI -1.28 to 1.04). After implementation, there was a likelihood of a favorable discharge outcome (OR 1.74, 95% CI 1.29-2.36) and transfer to a rehabilitation hospital (OR 1.77, 95% CI 1.23-2.54). This change was associated with a more favorable transition to post-acute rehabilitation without improving short-term mortality.