Special Report: Focusing on Performance

Rehab facility improved its discharges home rate

Rates at New Jersey facility increased 7%

It’s always a challenge for a rehab facility to make certain discharges to home remain high, despite the many challenges that patients will face. When administrators at one New Jersey rehab facility noticed a drop in discharge disposition to home, they decided to implement their process improvement strategy to improve this trend, says Joan Alverzo, PhD, CRRN, chief clinical officer of Kessler Institute for Rehabilitation of West Orange, NJ, a Mechanicsburg, PA-based Select Medical Co. organization.

"We dug deeper to see if it was all related to patient diagnoses, associated with LOS [length of stay] or various comorbidities — the typical things you would look at," says Sue Kida, PT, MHA, assistant vice president of administration. "After looking at data, we decided to take action and formed a performance improvement [PI] committee to work toward improving discharge to the home environment."

The PI team measured discharge data against national mean and focused on trends in discharge disposition across facilities and categories, including a closer look at stroke and joint replacement patients. "Sometimes it’s easier or more effective to take certain portions of the data and work toward it as opposed to trying to improve the entry data pool," Kida says. "We looked at common diagnoses across all four sites and looked at discharge dispositions and what we could do to affect it," she notes.

After pulling the information together, the committee came up with an action plan on how to improve the discharge home, Kida says. Meetings were held to include staff’s input and to make them an active part of the process change, she adds. From this process, administrators learned that staff sometimes hesitate to discharge patients home out of safety concerns, such as concerns about patients getting into and out of the house and taking care of themselves, Kida explains. "There were a lot of discussions about what safety is and what is safe for a patient and what were the patient’s safety levels before coming to us," she says.

Then the committee discussed strategies for improving safety, such as focusing on certain gym therapy activities or having the patient stay overnight with a family member at the facility to practice handling the patient before the patient returns home, Kida continues.

Other areas that contributed to problems with discharging patients home were family pressure, complexity, and time required for home discharge, and expectations of patients/families regarding discharge disposition. The team reviewed current processes and designed an action plan, which was presented at each facility for all clinical staff, who were challenged to review the opportunity for discharging patients to home on every case.

Soon after initiating these changes, administrators noted an improvement in the discharge disposition home, from 80% to 84% in one quarter, Alverzo says. Administrators gave staff positive feedback about the improvements and let them know which processes had facilitated the improvement, she notes. "In the next and most recent quarters the discharge disposition home was 87%, which is close to the national benchmark," Alverzo adds. "So we went from a substandard rate of discharge home six quarters ago to being very much in line with discharging patients home when compared with other rehab hospitals across the country."