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General Rehabilitation

Identifying which patients are at risk of an unplanned transfer from an inpatient rehabilitation facility using the HOSPITAL score.

(Research Hub Theater) Identifying Which Patients Are at Risk of an Unplanned Transfer from an Inpatient Rehabilitation Facility Using the HOSPITAL Score

Thursday, November 16, 2023
5:00 PM – 7:00 PM CT

    Primary Author(s)

  • Christopher W. Lewis, MD (he/him/his)

    Clinical Informatics Fellow
    University of Washington
    Seattle, Washington

    • Co-Author(s)

  • JS

    James A. Sliwa, DO

    Chief Medical Officer/ Professor Dept of Physical Medicine and Rehabilitation
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Munster, Indiana

  • PK

    Peter Kallas, MD

    Assistant Professor
    Northwestern University Feinberg School of Medicine
    Chicago, Illinois

Background and/or Objectives: Prior research has shown that patients admitted to inpatient rehabilitation facilities (IRF) have a 10% chance of an unplanned transfer back to an acute care hospital. While studies have identified patient-specific factors associated with unplanned transfers, in this study we aim to evaluate the utility of the HOSPITAL score in this population, a validated prediction model which predicts the 30-day potential for hospital readmissions.

Design: Retrospective case-control study.

Setting: IRF.

Participants: Patients admitted to IRF between January 1, 2015 and May 31, 2019.

Interventions: Not applicable.

Main Outcome Measures: Cases included patients admitted to IRF with an unplanned transfer back to acute care. Controls were admitted to IRF but didn't have an unplanned transfer. The HOSPITAL score ranges from 0-13. Scores were grouped into low (0-4), medium (5-6), and high risk (≥7) for unplanned transfer.

Results: Initial IRF encounters from 3,064 patients were identified during the study period, including 579 patients (19%) with an unplanned transfer. The median HOSPITAL score was 4 (mean 4.4, SD, 1.6, range 0-12). Patients were more likely to have higher HOSPITAL scores if they had an unplanned transfer (n=579, mean 5.0, SD 1.6) when compared to patients without an unplanned transfer (n=2,485, mean 4.2, SD 1.6, p< 0.0001). In a multivariate logistic regression analysis, patients were more likely to have an unplanned transfer if their HOSPITAL score was intermediate risk (OR 1.73, 95% CI 1.42-2.13, P< 0.001) or high risk (OR 2.80, 95% CI 2.08-3.77), they were male (OR 1.33, 95% CI 1.10-1.63, P=0.004), or a longer length of stay (OR 0.93 per day, 95% CI 0.92-0.94, P< 0.001).

Conclusions: Unplanned transfers from IRF to acute care are significantly associated with the HOSPITAL score. This tool could be used by physiatrists to screen patients being considered for discharge to an IRF to determine the patient’s risk of an unplanned transfer back to acute care.