title: Readmission to an Acute Care Hospital During Inpatient Rehabilitation for Traumatic Brain Injury.
abstract: OBJECTIVE
  To assess the incidence of, causes for, and factors associated with readmission to an acute care hospital (RTAC) during inpatient rehabilitation for traumatic brain injury (TBI).
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  Inpatient rehabilitation.
  
  
  METHODS
  Individuals with TBI admitted consecutively for inpatient rehabilitation (N=2130).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  RTAC incidence, RTAC causes, rehabilitation length of stay (RLOS), and rehabilitation discharge location.
  
  
  RESULTS
  A total of 183 participants (9%) experienced RTAC for a total of 210 episodes. Of 183 participants, 161 patients experienced 1 RTAC episode, 17 had 2, and 5 had 3. The mean time from rehabilitation admission to first RTAC was 22±22 days. The mean duration in acute care during RTAC was 7±8 days. Eighty-four participants (46%) had ≥1 RTAC episodes for medical reasons, 102 (56%) had ≥1 RTAC episodes for surgical reasons, and 6 (3%) participants had RTAC episodes for unknown reasons. Most common surgical RTAC reasons were neurosurgical (65%), pulmonary (9%), infection (5%), and orthopedic (5%); most common medical reasons were infection (26%), neurological (23%), and cardiac (12%). Any RTAC was predicted as more likely for patients with older age, history of coronary artery disease, history of congestive heart failure, acute care diagnosis of depression, craniotomy or craniectomy during acute care, and presence of dysphagia at rehabilitation admission. RTAC was less likely for patients with higher admission FIM motor scores and education less than high school diploma. RTAC occurrence during rehabilitation was significantly associated with longer RLOS and smaller likelihood of discharge home.
  
  
  CONCLUSIONS
  Approximately 9% of patients with TBI experienced RTAC episodes during inpatient rehabilitation for various medical and surgical reasons. This information may help inform interventions aimed at reducing interruptions in rehabilitation for RTAC. RTACs were associated with longer RLOS and discharge to an institutional setting.
authors.affiliation: Carolinas Rehabilitation, Charlotte, NC; Indiana University School of Medicine, Indianapolis, IN. Electronic address: flora.hammond@rhin.com.
authors.forename: Flora M
authors.initials: FM
authors.lastname: Hammond
authors.affiliation: Institute for Clinical Outcomes Research, Salt Lake City, UT.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
authors.affiliation: Institute for Clinical Outcomes Research, Salt Lake City, UT.
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Smout
authors.affiliation: Brooks Rehabilitation Hospital, Jacksonville, FL.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Beaulieu
authors.affiliation: Institute for Clinical Outcomes Research, Salt Lake City, UT.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Barrett
authors.affiliation: Intermountain Medical Center, Salt Lake City, UT.
authors.forename: David K
authors.initials: DK
authors.lastname: Ryser
authors.affiliation: Rush University Medical Center, Chicago, IL.
authors.forename: Teri
authors.initials: T
authors.lastname: Sommerfeld
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D002170:Canada; D015331:Cohort Studies; D004185:Disability Evaluation; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome; D014481:United States
keywords: Brain injuries; Comorbidity; Hospitalization; Patient readmission; Rehabilitation