A quality improvement initiative for improving appropriateness of referrals from a cancer center to subacute rehabilitation.
BACKGROUND
Subacute rehabilitation may not be appropriate for many patients with advanced cancer. We evaluated outcomes of cancer center inpatients transferred to subacute rehabilitation, implemented a multidisciplinary intervention to improve appropriateness of referrals, and evaluated its potential impact.


METHODS
Percentage of patients who returned for further anticancer treatment after subacute rehabilitation (preintervention) and percentage of patients who were referred and transferred to subacute rehabilitation (pre and post).


METHODS
Stakeholder engagement; feedback about outcomes to faculty and staff; increased communication between therapy, social work, nursing, and physicians about therapy referrals; and goals of care at daily prerounds meeting.


RESULTS
Potential reduction in subacute rehabilitation referrals and transfers. Intensive intervention was difficult to maintain, but team is continuing efforts at improved communication.


CONCLUSIONS
Intervention may have improved outcomes short-term but was complicated and difficult to maintain. Addressing appropriateness of subacute rehabilitation referrals can occur within a multidisciplinary approach to improving communication about goals of care for patients with advanced disease.
The Harry J. Duffey Family Pain and Palliative Care Program, Johns Hopkins Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland, USA. Electronic address: sdy@jhsph.edu.
Sydney M
SM
Dy
The Harry J. Duffey Family Pain and Palliative Care Program, Johns Hopkins Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Donald J
DJ
List
Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Cynthia
C
Barbe
The Harry J. Duffey Family Pain and Palliative Care Program, Johns Hopkins Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Louise
L
Knight
D002173:Cancer Care Facilities; D003142:Communication; D006801:Humans; D009369:Neoplasms / Q000534:rehabilitation / Q000628:therapy; D010166:Palliative Care / Q000379:methods; D058996:Quality Improvement; D012017:Referral and Consultation; D012047:Rehabilitation Centers
Palliative care; goals of care; physical therapy; quality improvement; subacute rehabilitation