Invited Commentary

Commentary on “Inpatient Rehabilitation Centers and Concern for Increasing Volume of Ischemic Stroke Patients Requiring Rehabilitation”

Authors: William J. Powers, MD

Abstract

In this issue of the Southern Medical Journal, Martin-Schild and colleagues report a retrospective analysis of patients hospitalized with acute ischemic stroke who had prolonged length of stay (pLOS).1 The reasons for pLOS were varied and included neurological and non-neurological medical complications, delays in imaging and procedures, and delays in discharge disposition, the latter accounting for almost half of the total. A pLOS in an acute care hospital after stroke beyond that which is medically necessary is not only poor use of costly inpatient resources but also not in a patient’s best interest because of the increased risk of hospital-acquired infections and the delay in instituting a comprehensive rehabilitation program.2

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References

1. Seigler JE, Boehme AK, Fowler BD, et al. Inpatient rehabilitation centers and concern for increasing volume of ischemic stroke patients requiring rehabilitation. South Med J. 2013; 106: 693–696.
 
2. Forster AJ, Taljaard M, Oake N, et al. The effect of hospital acquired infection with Clostridium difficile on length of stay in hospital. CMAJ. 2012; 184: 37–42.
 
3. Shay PD, Mick SS. Post-acute care and vertical integration after the Patient Protection and Affordable Care Act. J Healthc Manag. 2013; 58: 15–27.
 
4. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke. Stroke. 2013; 44: 870–947.
 
5. Brusco NK, Taylor NF, Watts JJ, et al. Economic evaluation of adult rehabilitation: a systematic review and meta-analysis of randomized controlled trials in a variety of settings. Arch Phys Med Rehab. 2013;Apr 3 [Epub ahead of print]