Integration of trauma and rehabilitation services is the answer to more cost-effective care

• Published in: ANZ journal of surgery Vol. 86; no. 11; pp. 900 - 904
• Main Authors: Wu, Jane, Faux, Steven G., Harris, Ian, Poulos, Christopher J.
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-11-2016
• Subjects: Brain injury; Cost-Benefit Analysis; cost-effectiveness; delivery of health care; Female; Follow-Up Studies; Health care expenditures; Humans; Inpatients; Length of Stay - economics; Male; Motor vehicles; New South Wales; outcome and process of assessment (health care); Recovery of Function; Rehabilitation; Retrospective Studies; Spinal cord injuries; Trauma; Trauma centers; Trauma Centers - economics; Wounds and Injuries - economics; Wounds and Injuries - rehabilitation; trauma; cost-effectiveness; rehabilitation; delivery of health care; outcome and process of assessment (health care)
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.13389

Background
The pathway from acute trauma care to inpatient rehabilitation has not been previously studied in New South Wales (NSW), Australia. This study aimed to examine the outcomes of patients transferred from a trauma service to its ‘in‐house’ rehabilitation service (Group A) compared with outcomes of patients transferred from a designated trauma centre to an external rehabilitation service (Group B). This is carried out to identify any inefficiencies, delays and opportunities for improvement.
Methods
This is a retrospective cohort study using linked registry data. This study included all patients admitted after a motor vehicle collision to trauma services in NSW over the period of 2009–2012, who required inpatient rehabilitation. Those requiring specialized brain or spinal injury rehabilitation or those who went to private rehabilitation units were excluded.
Results
There were 249 patients in this cohort with majority (59%) in Group A and the remainder in Group B. There was no significant difference between the age of the patients, injury severity or acute length of stay (LOS) between the two groups. Admission and discharge functional independence measure scores were also similar between the two groups. There was a significant difference in the LOS in rehabilitation (30 days for Group A compared with 40 days in Group B, P = 0.02).
Conclusions
Transferring patients to an external rehabilitation service from a designated trauma service is less efficient than providing the same care by the ‘in‐house’ rehabilitation service. There may be opportunities to improve the efficiency of trauma management and reduce costs.