Reducing the length of stay for acute hospital patients needing admission into inpatient rehabilitation: a multicentre study of process barriers

Intern Med J. 2013 Sep;43(9):1005-11. doi: 10.1111/imj.12227.


Background: Patient flow is a major problem in hospitals. Delays in accessing inpatient rehabilitation have not been well studied.

Aims: Measure the time taken for key processes in the patient journey from acute hospital admission through to inpatient rehabilitation admission in order to identify opportunities for improvement.

Methods: Retrospective open cohort study. All patients admitted over 8- and 10-month periods during 2008 into two inpatient rehabilitation units in Melbourne, Australia. Main outcome measures were the duration of the following key processes: acute hospital admission until referral for rehabilitation, referral until assessment by the rehabilitation service, assessment until deemed ready for transfer to rehabilitation, ready for transfer until rehabilitation admission.

Results: Three hundred and sixty patients were in the study sample (females = 186; 51.7%); mean age = 58.4 (standard deviation = 15.0) years. There was a median of 7 (interquartile range [IQR] 4-13) days from acute hospital admission till referral for rehabilitation, a median of 1 (IQR 0-1) day from referral till assessment, a median of 0 (IQR 0-2) days from assessment till deemed ready for transfer and a median of 1 (IQR 0-3) day from ready till admission into rehabilitation. Overall, patients spent 12.0% (804/6682) of their acute hospital admission waiting for a rehabilitation bed.

Conclusions: There are opportunities to improve the efficiency of key processes in the acute hospital journey for patients subsequently admitted to inpatient rehabilitation; in particular, reducing the time from acute hospital admission till referral for rehabilitation and from being deemed ready for transfer to rehabilitation till admission.

Keywords: delivery of healthcare; health service accessibility; outcome and process assessment (healthcare); patient discharge; rehabilitation.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Hospitalization / trends
  • Humans
  • Length of Stay* / trends
  • Male
  • Middle Aged
  • Patient Admission / standards*
  • Patient Admission / trends
  • Patient Transfer / standards*
  • Patient Transfer / trends
  • Process Assessment, Health Care / standards*
  • Process Assessment, Health Care / trends
  • Referral and Consultation / standards*
  • Referral and Consultation / trends
  • Rehabilitation Centers / standards*
  • Retrospective Studies
  • Time Factors
  • Young Adult