title: Integration of trauma and rehabilitation services is the answer to more cost-effective care.
abstract: BACKGROUND
  The pathway from acute trauma care to inpatient rehabilitation has not been previously studied in New South Wales (NSW), Australia. This study aimed to examine the outcomes of patients transferred from a trauma service to its 'in-house' rehabilitation service (Group A) compared with outcomes of patients transferred from a designated trauma centre to an external rehabilitation service (Group B). This is carried out to identify any inefficiencies, delays and opportunities for improvement.
  
  
  METHODS
  This is a retrospective cohort study using linked registry data. This study included all patients admitted after a motor vehicle collision to trauma services in NSW over the period of 2009-2012, who required inpatient rehabilitation. Those requiring specialized brain or spinal injury rehabilitation or those who went to private rehabilitation units were excluded.
  
  
  RESULTS
  There were 249 patients in this cohort with majority (59%) in Group A and the remainder in Group B. There was no significant difference between the age of the patients, injury severity or acute length of stay (LOS) between the two groups. Admission and discharge functional independence measure scores were also similar between the two groups. There was a significant difference in the LOS in rehabilitation (30 days for Group A compared with 40 days in Group B, P = 0.02).
  
  
  CONCLUSIONS
  Transferring patients to an external rehabilitation service from a designated trauma service is less efficient than providing the same care by the 'in-house' rehabilitation service. There may be opportunities to improve the efficiency of trauma management and reduce costs.
authors.affiliation: St. Vincent's Hospital, Sydney, New South Wales, Australia. jane.wu@svha.org.au.
authors.forename: Jane
authors.initials: J
authors.lastname: Wu
authors.affiliation: St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Faux
authors.affiliation: South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.|Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Harris
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Poulos
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D008297:Male; D009517:New South Wales; D020127:Recovery of Function; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics*; D014947:Wounds and Injuries / Q000191:economics / Q000534:rehabilitation*
keywords: cost-effectiveness; delivery of health care; outcome and process of assessment (health care); rehabilitation; trauma