Current trends in the length of stay in neurological early rehabilitation

Abstract

Background: Neurological early rehabilitation (phase B) is an integral component of the phase model of the German Federal Rehabilitation Council (Bundesarbeitsgemeinschaft für Rehabilitation, BAR). We studied the current trend in patients' length of stay.

Methods: This study included 2060 cases of the BDH-Klinik Hessisch Oldendorf (a neurological rehabilitation clinic) from 2005 to 2008 that fulfilled the structural characteristics of item 8-552 of the German coding system for operations and procedures (Operationen- und Prozedurenschlüssel, OPS), which codes for neurological and neurosurgical early rehabilitation. We studied the parameters age, sex, length of stay, type of discharge, diagnoses, and morbidity. 75.7% of the collective carried a diagnosis of cerebral ischemia, traumatic brain injury, or intracerebral hemorrhage.

Results: The mean length of stay over the entire period of the study was 44.6 days. A successive reduction of the mean length of stay from 2005 to 2008 was evident, from 46.8 days in 2005 to 37.5 in 2008 (p<0.001). The morbidity, too, declined over the period of the study. 76.4% of the cases analyzed stayed in hospital for at least the minimum of 8 weeks proposed by the BAR. 39.5% of the patients improved to such an extent in phase B that they were able to be transferred to a further rehabilitation facility, while about one patient in five was transferred from early rehabilitation to a nursing facility. The mortality was 0.9%. Although the early rehabilitation procedure was correctly coded, a total of 60 different diagnosis-related groups (DRGs) were applied.

Conclusion: These data support the BAR's recommendation for a minimum length of stay of 8 weeks in phase B. The observed shortening of the length of stay was found to be primarily the result of a reduction in morbidity during early rehabilitation. This, in turn, may well be due to a selection effect of the early rehabilitation procedure code 8-552.

Figure 1

Patients’ mean length of stay (in days) from 2005 to 2008. The dark bars show mean lengths of stay, the light bars show mean lengths of stay adjusted for death, transfer to an acute ward, transfer to a hospice, and discharge against medical advice. The case numbers were as follows: 2005, n=578; 2006, n=580; 2007, n=541; 2008, n=361.

Figure 2

Distribution of cases over months of treatment. The dark bars show the percentage of the cases discharged in each time period. The light bars show the lengths of stay adjusted for death, transfer to an acute ward, transfer to a hospice, and discharge against medical advice

Figure 3

Length of stay on the basis of early rehabilitation Barthel index ^*1 p<0.05 ^*2 p<0.001