Admission Thresholds and Outcomes in Inpatient Rehabilitation: A National Analysis

To analyse referrals and admissions to Malta's sole inpatient rehabilitation facility, identifying emerging trends and challenges over recent years.

A retrospective, population-based analysis was conducted on all in-patient rehabilitation referrals in Malta between July 1, 2022, and December 31, 2023. Referral outcomes, acceptance rates, and primary admission diagnoses were examined. Results were compared to a similar study in 2018. A follow-up questionnaire was designed to look at Rehabilitation outcomes in the 01.07.2022 to 31.12.2023 cohort at 2 years post discharge home.

1) To identify key shifts in admission process, length of stay and rehabilitation outcomes, thereby providing evidence to enhance in-patient rehabilitation selection and guide international rehabilitation strategies 2) To assess rehabilitation functional outcomes of an inpatient rehabilitation program and 2 years post discharge.

407 referrals were placed. Of these, 357 were new referrals, 73.1% (n=261) were accepted-a notable rise from 47% in 2018. Non-acceptance was recorded in 96 cases, while 50 patients were discharged or deceased before review. Both the mean (59 → 92) and median (22 → 59) length of stay increased over the 6-year period, reflecting an increase in both outliers due to social issues but also a shift towards longer length of stays in general. Despite this shift, the number of patients discharged to their own home fell from 90% to 79% with 12.3% being re-admitted to the acute hospital, 8.2% being discharged to a long-term care facility and 1 individual passing away.

As a population-based analysis of national in-patient rehabilitation data, this study provides insights into shortcomings in the efficiency and effectiveness of inpatient rehabilitation services. Analysis into the variables that might have contributed to these findings may serve as a framework for rehabilitation policies worldwide. Future research should investigate barriers influencing discharge and long-term rehabilitation success.