Trauma-rehabilitation connections: discharge and admission decisions for children.
Paediatric discharge coordinators and rehabilitation admission coordinators were surveyed about how children are selected for rehabilitation. The following areas are covered: (1) the decision process, and how children are selected for rehabilitation; (2) who is involved in making acute-care discharge and rehabilitation admission decisions; (3) factors that guide selection of children for rehabilitation; and (4) satisfaction with referral practices. Surveys were completed by 30 trauma discharge and rehabilitation admission coordinators, recruited from paediatric trauma units and paediatric/general rehabilitation units nationwide. Most respondents were satisfied with transfers, although some voiced concerns about constraints placed on referrals by insurance. Even when inpatient rehabilitation was clearly needed, 40% said insurance status still affected whether children were admitted. There was little evidence that any uniform criteria are used to make decisions. Half had no training in discharge/admission planning and half did not base decisions on functional assessments. Although guidelines are increasingly used in clinical decision-making, few are available concerning critical decisions about which children receive inpatient rehabilitation following trauma.
Department of Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, Massachusetts, USA.
J S
JS
Osberg
C A
CA
Unsworth
D000553:Ambulatory Care; D002648:Child; D003657:Decision Making; D005190:Family; D017408:Guidelines as Topic; D006297:Health Services Accessibility; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D010343:Patient Admission; D010351:Patient Discharge; D010358:Patient Participation; D018579:Patient Selection; D010549:Personal Satisfaction; D012017:Referral and Consultation; D012047:Rehabilitation Centers / Q000458:organization & administration; D014193:Trauma Centers / Q000458:organization & administration; D014947:Wounds and Injuries / Q000534:rehabilitation*