Quality improvement for rehabilitation facilities

Rehabilitation quality is about function: how much patients improve, whether they go home and how efficiently they get there. Many quality platforms are built around acute care measures such as inpatient mortality, and applying the wrong framework adds reporting without insight.

Falls are among the most common adverse events in inpatient rehabilitation, and they need clinical context. A patient who falls while transferring independently may be doing exactly what the therapy plan intends. The fall is still a safety event, but reviewing it without knowing the mobility goal produces anxiety rather than learning.

Reporting obligations grow with census. The Inpatient Rehabilitation Facility Quality Reporting Program draws on assessment data collected for every Medicare patient, and facilities that manage it by hand carry a heavy administrative load.

Inpatient rehabilitation facilities (IRFs) collect the IRF Patient Assessment Instrument (IRF-PAI) for each Medicare patient. CMS removed the FIM items from the IRF-PAI from October 1, 2019; function is now measured with the standardized Section GG items, which also drive payment groups.

• IRF Quality Reporting Program measures include the Discharge Function Score, falls with major injury, changes in skin integrity (pressure ulcers and injuries), discharge to community and potentially preventable readmissions after discharge.
• The 60% rule (42 CFR 412.29) requires that at least 60% of an IRF's patients need intensive rehabilitation for one of 13 qualifying conditions.

1. 1Track the Discharge Function Score and discharge to community by diagnosis group, alongside your safety measures.
2. 2Add mobility context to every fall report: whether the patient was mobilizing per the therapy plan, the level of assistance and whether the transfer was supervised.
3. 3Create event categories for therapy sessions, such as overexertion, equipment failures and clinical changes during treatment.
4. 4Review falls with major injury and skin integrity measures monthly with nursing and therapy together.
5. 5Run one improvement project on the outcome where you lag your peers most.

• Functional outcome and safety measures in one place, each with a named owner and a review rhythm.
• Daily measures on the unit huddle board, weekly department trends and monthly views for leadership and the quality committee.
• Off-target measures linked to the improvement project addressing them, so you can see whether the work is moving the number.