Managing the interface between acute care and rehabilitation - can utilisation review assist?
OBJECTIVE
We piloted the InterQual Criteria tool in a large regional acute hospital in NSW to determine the utility of this tool in the Australian context. In particular to compare the current "gold standard" of physician assessment for the selection of patients for rehabilitation and the timing of transfer, with the guidance provided by the tool. Consecutive acute care patients with a diagnosis of stroke, hip fracture or amputation, and patients referred for rehabilitation assessment, were followed using the InterQual Criteria.


RESULTS
Results on 242 acute episodes, representing 2698 days in acute care, were analysed. In accordance with overseas studies, we found that high levels of inappropriate days of stay in acute care were suggested by the tool. Using the InterQual Criteria almost all patients were deemed appropriate for transfer to rehabilitation much earlier than current practice.


CONCLUSIONS
We conclude that the InterQual Criteria may have a useful role in patient selection for rehabilitation, in facilitating the transfer of patients from acute to subacute care, and in improving patient flow within acute care. The reasons for the variation between the results obtained from the tool and current clinical practice requires further investigation, and may indicate a lack of validity of the tool in the Australian setting, inefficiencies in processes of acute care, or the lack of suitable alternative care settings or level of support available in these settings.
Poulos
Christopher J
CJ
Department of Rehabilitation, South Eastern Sydney and Illawarra Area Health Service, Port Kembla Hospital, Cowper St, Wollongong, NSW. chris.poulos@sesiahs.health.nsw.gov.au
Eagar
Kathy
K
Poulos
Roslyn G
RG
D000328:Adult; D000359:Aftercare / Q000458:organization & administration / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D003211:Concurrent Review; D017050:Episode of Care; D006300:Health Services Misuse; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009517:New South Wales; D019982:Organizational Case Studies; D018579:Patient Selection; D010360:Patient Transfer / Q000592:standards*; D010865:Pilot Projects; D019984:Quality Indicators, Health Care; D012047:Rehabilitation Centers / Q000458:organization & administration / Q000706:statistics & numerical data*