Piloting the Stratification of a Geriatric Intermediate Bed- Based Rehabilitation Service

Rehabilitation is defined as “a process of assessment, treatment and management by which the individual (and their family/carers) are supported to achieve their maximum potential for physical, cognitive, social and psychological function, participation in society and quality of living. Patient goals for rehabilitation vary according to the trajectory and stage of their condition.”. (British Society of Rehabilitation Medicine, 2019).

Following an acute hospital admission, there are various discharge pathways supported by the NHS, under the Discharge to Assess model (Appendix 1)(NHS England, 2015). Pathway 2 within the Discharge to Assess model, is the transfer of a patient from Acute Hospital to Intermediate care-including Bed-Based Rehabilitation (BBICT) and Specialist Rehabilitation services (NHS England, 2015) .

The National Institute of Clinical Excellence (NICE) outlines BBICT as a service that provides assessment and interventions in a bed-based setting, such as an acute hospital, community hospital, residential care home, nursing home, stand-alone intermediate care facility, independent sector facility, local authority facility or other bed-based setting. Bedbased intermediate care aims to prevent unnecessary admissions to acute hospitals and premature admissions to long-term care, and to support timely discharge from hospital. For most people, interventions last up to 6 weeks and are provided by a multidisciplinary team (NICE, 2017).

Keywords: Rehabilitation for patient with highly complex needs, Geriatric Hospital Discharge, UKROC.