Methods: For inpatient stroke rehabilitation, the Ministry of Health in Ontario sets length of stay (LOS) targets based on evidence for each of seven Stroke Rehabilitation Patient Groups (RPG). From June 2016 to February 2018 we monitored deviations from the recommended length of stay for all stroke clients admitted to a 26-bed inpatient stroke rehabilitation unit. RPGs classify admitted patients using an algorithm based on age and scores on the Functional Independence Measure, into categories based on burden of care, ranging from mild disability to severe disability.

Analysis: 156 admissions were analyzed for number of days deviating from the LOS targets by RPG and reasons for that deviation. Discharge destination was also considered.

Results: Cases were identified in which LOS targets were exceeded (patients stayed beyond the recommended time) or when actual LOS was shorter than the recommended target. Patients discharged early had met their rehabilitation goals and these cases resulted in a total of 510 ‘saved’ days. While patients exceeding the recommended LOS accounted for a total of 579 additional days in hospital. These patients did so for a variety of reasons. Medical complications and mobility/ADL goals not yet met were the two most common reasons for delay in discharge, with delays caused by discharge planning and goals for dysphagia being the next two most common reasons. 

Conclusion: Identifying themes contributing to cases in which best practice LOS targets are exceeded will help to identify health services needed in order to proactively address these issues and improve flow.

FACTORS CONTRIBUTING TO DEVIATIONS FROM BEST PRACTICE LENGTH OF STAY TARGETS FOR INPATIENT STROKE REHABILITATION BY PATIENT GROUP