Effectively transferring patients to rehab.
Patients who return to the acute care hospital after rehab often did not meet criteria for acute rehabilitation services. Include detailed documentation in the discharge summary, including information on the patient's behavior and mental status at different times of the day. Educating the patient and family about how rehab is different from acute care helps them adjust quickly to the new level of care. Make sure patients are medically stable and can tolerate three hours of rehab a day.
D019090:Case Management; D006785:Hospitals, University; D006801:Humans; D019982:Organizational Case Studies; D010359:Patient Readmission; D010360:Patient Transfer / Q000458:organization & administration / Q000592:standards*; D012046:Rehabilitation; D014768:Virginia