Avoiding Missed Minutes: Improving Therapy Participation in Brain Injury Rehabilitation, A Quality Improvement Initiative.

Abstract: Patient participation in therapy sessions during inpatient rehabilitation is essential to maximize recovery. While specific reasons for missed therapies have not been studied in the brain injury population, individuals with brain injuries are often medically complex, which may impact participation. This quality improvement (QI) study aimed to deepen the understanding of reasons for missed therapy and design an intervention to improve therapy participation in an inpatient brain injury rehabilitation unit. Over two consecutive years, data on missed therapies were collected in a rehabilitation unit. Pre-intervention analysis established three categories of missed therapy, including medical complications (67.4%), routine medical testing (20.9%), and nursing care (11.6%). Therapy was commonly missed on Mondays (21%) and often missed for the entire day (35%). An intervention was designed and implemented to improve communication of weekend medical events, aimed at reducing missed therapies on Mondays. After implementation, there was a statistically significant decrease in missed or rescheduled therapies on Mondays (p = 0.017) and in the number of "all day" missed sessions (p = 0.018). This QI study provides valuable data on trends in missed therapy sessions for individuals with brain injury during inpatient rehabilitation, as well as a successful intervention.