Patient flow problems affecting in-patient spinal cord injury rehabilitation in the Netherlands.

Abstract

Study design: Prospective cohort study.

Objectives: To describe barriers to admission to and discharge from an inpatient rehabilitation unit for patients with newly acquired spinal cord injury or disease (SCI/D) and to identify modifiable factors whereby patient flow can be optimized.

Setting: Netherlands.

Methods: In-patients with newly acquired SCI/D referred to a rehabilitation centre in the Netherlands between December 2018 and December 2019 were included. Demographic, clinical characteristics and information about waiting days and causes of delay were recorded. Descriptive analysis was used.

Results: In total, 105 patients were included; 33 patients (31%) were female, mean age was 59 years, 60% had a non-traumatic SCI/D, 42% of the SCI/D were tetraplegia and 62% were AIS D at referral. No significant differences in demographic or clinical characteristics were found between patients with and without a barrier to admission. Most common admission barriers were bed availability and capacity of nursing and other health staff. The most frequent discharge barriers were delay in care approval, lack of availability of nursing home places and waiting for home modifications.

Conclusion: Most frequent admission barriers were availability of beds and staffing capacity; most discharge barriers were problems with home modifications, waiting for care approval or a nursing home place. Recommendations for reducing these barriers are recognizing a potential problem at an early stage, timely communication with patient and/or family about options for discharge, while simultaneously initiating a home modification plan and exploring temporary accommodation options.