Patient flow implications of delayed access to inpatient rehabilitation in Australian acute hospitals

OBJECTIVE: Delays in transferring patients from acute care to inpatient rehabilitation contribute to hospital exit-block; however, the magnitude of rehabilitation-related delays is poorly quantified in contemporary health systems. This study aimed to quantify the time spent waiting for inpatient rehabilitation in Australian acute hospitals. METHODS: Secondary analysis of a prospective observational cohort study of consecutive adult patients accepted for inpatient rehabilitation across two metropolitan tertiary hospitals in Sydney, Australia, over a 4-month period was performed. The main outcome measures were the time from rehabilitation readiness to transfer, and the proportion of acute bed-days spent waiting for rehabilitation. RESULTS: Among the 373 patients accepted for inpatient rehabilitation, a total of 1499 acute bed-days were spent waiting for transfer. The overall acute length of stay for the cohort was 7953 days, indicating that 18.8% of all acute bed-days were occupied by patients waiting for rehabilitation transfer. The median wait time was 2 days (IQR 1-6). Although 40% of patients were transferred within 1 day of being deemed ready for rehabilitation, 42% waited ≥4 days, and 15.7% experienced delays exceeding 1 week. CONCLUSIONS: Delayed access to inpatient rehabilitation makes a substantial contribution to acute bed occupancy. Nearly one-fifth of acute bed-days among patients requiring inpatient rehabilitation were spent waiting for transfer. Strategies such as earlier identification of rehabilitation needs, in-reach rehabilitation in acute care, and expansion of subacute capacity may help reduce delays and improve hospital throughput.