A quality improvement initiative for improving appropriateness of referrals from a cancer center to subacute rehabilitation

Background Subacute rehabilitation may not be appropriate for many patients with advanced cancer. We evaluated outcomes of cancer center inpatients transferred to subacute rehabilitation, implemented a multidisciplinary intervention to improve appropriateness of referrals, and evaluated its potential impact. Measures Percentage of patients who returned for further anticancer treatment after subacute rehabilitation (preintervention) and percentage of patients who were referred and transferred to subacute rehabilitation (pre and post). Intervention Stakeholder engagement; feedback about outcomes to faculty and staff; increased communication between therapy, social work, nursing, and physicians about therapy referrals; and goals of care at daily prerounds meeting. Outcomes Potential reduction in subacute rehabilitation referrals and transfers. Intensive intervention was difficult to maintain, but team is continuing efforts at improved communication. Conclusions/Lessons Learned Intervention may have improved outcomes short-term but was complicated and difficult to maintain. Addressing appropriateness of subacute rehabilitation referrals can occur within a multidisciplinary approach to improving communication about goals of care for patients with advanced disease.