Inpatient rehabilitation: the correlation between functional gains and appropriateness of admissions

All admissions to an acute rehabilitation unit were later critiqued by the rehabilitation team to determine appropriateness of admissions. The physiatrist alone evaluated the patient for admission. From the team which worked with the patient, a physical therapist, occupational therapist and a nurse were asked to evaluate the appropriateness of the admission; a decision on appropriateness had to be supported by at least two of these three. The team scored patients with the Functional Independence Measure (FIM) on admission, weekly, and at discharge. In a six-month period there were 60 appropriate admissions and ten inappropriate admissions. The average length of stay was 38.3 days for appropriate and 17.3 days for inappropriate admissions. The appropriate gorup had an average initial FIM score of 40.6 and discharge score of 66.6. The inappropriate group started with high FIM scores, with an average of 61.0, and did not significantly improve their scores. Their average discharge score was 70.0. The rate of progress (efficiency ratio), in points per day, was 0.81 for the appropriate and 0.36 for the inappropriate group. Thus, there is a strong positive correlation between the rate of progress and appropriateness as assessed at discharge by the multidisciplinary team [corrected].