Optimizing Stroke Rehabilitation Services Utilization Through Use of the Modified Rankin Scale in an Acute Care Setting

Research Objectives: To increase utilization of the Stroke Counseling Consult and Rapid Access Outpatient Rehab referrals in the Acute Care setting to improve post discharge planning within the multi-disciplinary team.

Design: A needs assessment to improve discharge planning was completed in December 2021 via a survey sent to: Acute Stroke physicians, Case Managers/Social Workers, and Rehabilitation Services providers. Based on survey results, processes were implemented to initiate the use of the modified Rankin Scale by Acute Care Physical Therapists to provide baseline and current functional status data to the Stroke Interdisciplinary Team. Patients with a mRS greater than/equal to 3 received an automated consult to PM&R providers for Stroke Counseling and Rehabilitation needs.

Setting: Comprehensive Neurovascular and Stroke Center -- Acute Care Hospital.

Participants: May-Oct 2022: 359 Stroke discharges: 237 Stroke Counseling consults. 93 Inpatient Rehabilitation referrals (54 in-house), 43 Outpatient referrals (14 Outpatient Rapid Access).

Interventions: Survey - completed December 2021, Acute Physical Therapy documenting mRS, automation of Stroke Counseling consults based upon the mRS, Consultation and Outpatient referrals tracked from May to October 2022

Main Outcome Measures: Stroke Counseling consultations (direct referral to PM&R for Stroke medical management); Outpatient Rehabilitation Rapid Access referral

Results: Pre-automation data, January 2022 - April 2022, revealed approximately 1.7% (1 patient) of stroke admissions received both a Stroke Counseling consult and Outpatient Rehab referral. Documentation of mRS by Acute Care Physical Therapist began April 2022, automation of Stroke Counseling consults began May 2022. From May 2022 to October 2022, an average of 67% of stroke admissions (237 patients) received a Stroke Counseling consult and 12.8% (14 patients) were referred via Rapid Access Outpatient Rehab referral.

Conclusions: Through use of the modified Rankin Scale and automation of Stroke Counseling consults for rehabilitation needs assessment, we demonstrated an increase in overall usage of PM&R education including spasticity management, use of neurostimulants, and referrals to appropriate levels of care post-Acute Care discharge. This facilitated daily communication within our Stroke multi-disciplinary team.

Author(s) Disclosures: No conflicts of interest.