SHM Converge Scientific Abstract ePoster Gallery-Improving Discharge Rates to Home Versus Subacute Rehabs Following Hospitalization

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This quality-improvement project aimed to increase discharge-to-home rates and reduce discharge to subacute rehab (SAR) after hospitalization on one medical unit by 10% over three months. The team based the intervention on evidence that, for many patients, discharge home with support can produce functional outcomes similar to inpatient rehab, without worse pain or satisfaction.<br /><br />The project used a chart review to establish baseline discharge patterns and contributing factors. An ambulation policy was introduced for appropriate patients, requiring walking at least twice daily and eating meals out of bed. Patients with a Timed Up and Go (TUG) score below 14 were enrolled. Nurses and doctors reminded patients daily about mobility goals and documented counseling using a mobility chart/audit tool. Visual reminders were placed in patient rooms, and educational sessions were held for residents, nurses, physiotherapists, and hospitalists.<br /><br />Outcomes included discharge destination, compliance with the ambulation policy, and balancing measures such as falls, 30-day readmissions, length of stay, and employee satisfaction. Post-intervention surveys showed high awareness of the project (96.2%), but workflow changes were often seen as neither easy nor difficult, and many respondents found them difficult.<br /><br />The project faced several barriers: major workflow disruption, poor documentation compliance, fear of falls, multiple physical therapy discharge recommendations, and staffing limitations. The patient population also appeared less mobile and less independent after the intervention period, which may have limited improvement.<br /><br />Overall, the authors concluded that successful discharge home instead of SAR requires strong teamwork and consistent adherence to mobility practices. They suggest that future interdisciplinary discharge rounds and implementing the ambulation policy earlier, beginning with initial physical therapy assessment, may improve results.

Asset Subtitle

Ross Lavine

Meta Tag

Author List Anna-Belle Robertson, Dipal R. Patel, Fausto G. Lisung, Lena Makartian, Ross Lavine, Sofia Terner

Category Research

Concept Home Discharge

Concept Quality Improvement Intervention

Concept Subacute Rehabilitation

Concept Ambulation Policy

Concept Timed Up and Go Test

Distinguished Non-Finalist

Presenter Organization Englewood Health

Presenting Author Ross Lavine

Track Quality Improvement

Keywords

discharge to home

subacute rehab

quality improvement

ambulation policy

mobility goals

timed up and go

hospital discharge

physical therapy

workflow barriers

interdisciplinary teamwork

Home Discharge

Quality Improvement Intervention

Subacute Rehabilitation

Ambulation Policy

Timed Up and Go Test