A Retrospective Quality Improvement Study to Describe Operational Management Strategies in an Inpatient Rehabilitation Facility during the COVID-19 Pandemic

Struble-Fitzsimmons, Danielle; Feld-Glazman, Rachel; Dominick, Elizabeth; Alexandrou, Sandra; Rider, Elizabeth; Bogosian, Claudine; Norton, Jessica; Pacheco, Lisa; Andreassi, Eileen

The delivery of care in the inpatient rehabilitation setting was disrupted during the COVID-19 pandemic. As a 150 bed freestanding inpatient rehabilitation facility in the epicenter of the pandemic, Burke Rehabilitation Hospital was required to increase overall bed capacity for regional overflow needs and still maintain our mission to provide inpatient rehabilitation for patients with and without COVID-19. During the period between March and September 2020, Burke Rehabilitation Hospital treated over 300 COVID-19 positive rehabilitation patients, and at one point had a census that was greater than 50% COVID-19 positive. A model grounded in five priorities: communication, personal protective equipment, clinical service delivery, discharge planning, and patient/staff support was implemented to re-prioritize daily operations and ensure patient and staff safety while providing valuable rehabilitation services. The delivery of physical, occupational, speech, and recreational therapy services transformed, and a number of innovative clinical practices were developed. During the study period, 100% of our patients continued to be scheduled to receive therapy services. Patient length of stay values did increase during the pandemic (from 16.38 to 19.93 days), and slightly more patients were discharged to home (68.7% compared to 68.3%). Despite modifications to rehabilitation care delivery, patients continued to make functional gains in the areas of self-care, mobility, and walking. Flexible leadership was pivotal in the development and implementation of new processes and procedures to meet the evolving needs of patients, staff, and the organization as a whole.