Understanding quantity and intensity of hospital rehabilitation using electronic health record data

BackgroundMany hospitalised patients require rehabilitation during recovery from acute illness. We use routine data from electronic health records (EHR) to report the quantity and intensity of rehabilitation and compared this in patients with and without COVID-19. MethodsWe performed a retrospective cohort study of consecutive adults in whom COVID-19 testing was undertaken between March 2020 and August 2021 across three acute hospitals in Scotland. We defined rehabilitation contacts (physiotherapy, occupational therapy, dietetics and speech and language therapy) from timestamped EHR data and determined contact time from a linked workforce planning dataset. We included survivors to hospital discharge who received at least two rehabilitation contacts. The primary outcome was total rehabilitation time. Secondary outcomes included the number of contacts, time to first contact, and rehabilitation minutes per day. A multivariate regression analysis for predictors of rehabilitation time included age, sex, comorbidities, and socioeconomic status. FindingsWe included 11,591 consecutive unique patient admissions (76 [63,85] years, 56% female), of which 651 (6%) were with COVID-19, and 10,940 (94%) were admissions with negative testing. There were 128,646 rehabilitation contacts. Patients with COVID-19 received more than double the rehabilitation time compared to those without (365 [165,772] vs 170 [95,350] mins, p<0.001), and this was delivered over more specialist contacts (12 [6,25] vs 6 [3,11], p<0.001). Time to first rehabilitation contact was later in patients with COVID-19 (3 [1,5] vs 2 [1,4] days from admission). Overall, patients with COVID-19 received fewer minutes of rehabilitation per day of admission (14.1 [9.8,18.7] vs 15.6 [10.6,21.3], p<0.001). In our regression analyses, older age and COVID-19 were the most important predictors of increased rehabilitation time. InterpretationPatients with COVID received more rehabilitation contact time than those without COVID, but this was delivered less intensively. Rehabilitation data derived from the EHR represents a novel measure of delivered hospital care.