title: Impact of Early Inpatient Rehabilitation on Adult Burn Survivors' Functional Outcomes and Resource Utilization.
abstract: On July 2012, a rehabilitation hospital merged with a trauma center where the regional burn center is located. That rehabilitation center provides the only burn rehabilitation program in our region. The objective of this study was to determine if earlier initiation of inpatient rehabilitation after merger had an effect on burn survivors' functional outcomes and resource utilization. A retrospective review of electronic data of burn survivors' functional outcomes (functional independence measure [FIM] ratings on admission, at discharge, and percent change), and resource utilization (waiting time for rehab, burn center length of stay [LOS], rehab LOS, physiotherapy and occupational therapy rehabilitation workload [RehabWorkload], and discharge destination) was undertaken. Adult burn survivors who required inpatient rehabilitation and were transferred from the burn center to the inpatient rehabilitation service before the merger (July 2010-June 2012) were compared with those transferred after the merger (July 2012-June 2014). One hundred thirty-eight burn survivors were transferred from the burn center to the inpatient rehabilitation service during the study period. Sixty (43.5%) were transferred before and 78 (56.5%) were transferred after the merger. There were 97 (70.3%) men and 41 (29.7%) women with a mean age of 47.9 ± 17.9 years. TBSA burn was 24.2 ± 16.9%, and full thickness burn was 13.1 ± 16.4%. The etiology of these burns were flame (72.5%), scald (19.6%), electrical (5.1%), chemical (2.2%), and contact (0.7%). Patients in both groups had similar age, inhalation injury, TBSA, full thickness burn, FIM ratings, RehabWorkload, and burn etiology. Patients transferred before the merger had significantly more chemical burns (5% vs 0%, P = .046), and more work-related burns (26.7% vs 7.7%, P = .004). Patients transferred after the merger had significantly shorter burn center LOS (28.5 ± 20.9 days vs 38.8 ± 34.2 days, P = .043), and shorter waiting time for rehab (0.7 ± 1.1 days vs 1.5 ± 2.3 days, P = .010) than patients transferred before the merger. Early initiation of inpatient rehabilitation, after the burn center and the inpatient rehabilitation service were located in the same hospital, improved burn survivors' resource utilization.
authors.affiliation: From the *Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada; and †Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gomez
authors.forename: Morris
authors.initials: M
authors.lastname: Tushinski
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
mesh_terms: D000328:Adult; D000368:Aged; D002053:Burn Units / Q000458:organization & administration*; D002056:Burns / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006273:Health Facility Merger; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods; D009864:Ontario; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D012047:Rehabilitation Centers / Q000458:organization & administration*; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome