Poster 14: Measuring Rehabilitation Inputs in Relation to Caseload Complexity Using the Rehabilitation Complexity Scale

Article Outline

• Disclosures
• Objective
• Design
• Setting
• Participants
• Interventions
• Main Outcome Measures
• Results
• Conclusions
• Copyright

Keywords: Rehabilitation, Therapy, Nursing, Health services needs and demand

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Disclosures 

L. F. Turner Stokes, None.

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Objective 

To examine therapy and nursing inputs in relation to complexity of rehabilitation needs, measured by the Rehabilitation Complexity Scale (RCS).

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Design 

Analysis of serial (fortnightly) data records (n = 1206) from a prospective cohort collected over 30 months from 1/6/06 though 1/12/08.

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Setting 

A tertiary specialist inpatient neurological rehabilitation unit.

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Participants 

179 patients (mean age 44 years (SD14.8); M:F 110:69. Eighty-eight (49%) had stroke, 51 (28%) other acquired brain injury, 35 (20%) had spinal cord/peripheral neurological conditions.

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Interventions 

Multidisciplinary neurological rehabilitation.

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Main Outcome Measures 

The RCS records the complexity of rehabilitation needs in 3 subscales: Care+Nursing (C+N), Therapy (T), Medical (M). Cases were categorized by total RCS score as: 'Low' (4-6), 'Medium' (7-9), 'High' (10-12) and 'Very-high' (13-15) complexity. The Northwick Park Nursing and Therapy Dependency Scales record rehabilitation inputs. They translate respectively through validated computerized algorithms into evaluations of nursing/care hours (NCH) and therapy hours (TH) per week. All 3 instruments were recorded in parallel for all inpatients at fortnightly intervals.

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Results 

Across the whole sample, the median (IQR) RCS score was 11 (9-12); with nursing hours/week (NCH) mean (SD) 41.6 (19.4) and total therapy hours/week (TH) 22.8 (8.1). Within the different categories of rehabilitation complexity, the mean (SD) total staff hours/week were - Low: 27.4 (13.7); Medium: 46.5 (13.7); High: 68.4 (16.2); Very-high 90.4 (13.0). Strong correlations were seen between RCS-C+N scores vs nursing hours (NCH) (Spearman rho 0.83, P < .0001) and between RCS-T vs therapy hours (TH) (rho 0.75, P < .0001). Correlations across the therapy/nursing divide were weaker: RCS-C+N vs TH (rho 0.34) and RCS-T vs NCH (rho 0.17). RCS-M scores showed only moderate correlation with NCH (rho 0.31) and TH (rho 0.18).

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Conclusions 

The RCS provides a simple measure of complexity of rehabilitation needs which separates medical, nursing and therapy needs and correlates with respective staff inputs. Patients with Very-high RCS scores (13-15) required approximately twice the staff hours compared with patients who had Medium RCS scores. This has implications for costing.