Developing Admissions Pathways to Inpatient Rehabilitation Using NIH Stroke Scale

Research Objectives: To compare quality indicator outcomes before and after use of the NIH Stroke Scale previously reported range of 6-13 to identify inpatient rehabilitation candidates.

Design: Retrospective observational analysis using electronic medical record data.

Setting: A 114-bed freestanding, not-for-profit, inpatient rehabilitation hospital admitting persons after stroke from several regional hospitals.

Participants: Persons admitted with diagnosis of stroke and an NIH stroke scale of 6-13 will be treated as the comparison group. The baseline group will be persons admitted with a diagnosis of stroke prior to May 6, 2024 when the facility began recording the NIH Stroke Scale on pre-screening documentation.

Interventions: A change in practice to both record and utilize the NIH Stroke Scale to assist in admission decisions is used. Persons with stroke with an NIH Stroke Scale 6-13 will receive expedited review for admission. Persons with a referral outside of this range, will receive additional physician medical review and may still be admitted for rehabilitation.

Main Outcome Measures: We will identify the length of time from pre-screening admission to admission time to identify if the use of the NIH Stroke Scale's previously reported rehabilitation candidate cutoff caused meaningful decrease in amount of time to admit to our facility. Additionally, quality indicator measures will be examined to determine if the candidates chosen using NIH Stroke Scale criteria differed in independence and admission and discharge from the baseline group.

Results: After the start of this pilot program to date, 60 persons post stroke were admitted. 25 people (41%) of this group were within the target range of NIHSS 6-13. As a group, the average of the indicator walking subscale score was at discharge was 39.54. The group with NIHSS less than 6 and greater than 13 had an average walk admit of 46.3 and 34 respectively. The functional indicator change was 28 for the target group, 23.93 for people scoring less than 6 on the NIHSS and 19.67 for the people scoring greater than 13 on the NIHSS.

Conclusions: Persons who have had a stroke and are scored on the NIHSS of 6-13 and were admitted to our inpatient rehabilitation unit demonstrated greater improvement in a combination of self-care and mobility skills than persons admitted who scored above or below the target range. As previously established in literature, the NIH Stroke Scale can be an effective measure to identify inpatient rehabilitation candidates and improve continuity of care.

Author(s) Disclosures: The authors are both employed by Sheltering Arms Institute.