Rehab hospitals as a solution to the throughput crisis

The term “throughput” might be unfamiliar to most patients, but it plays a critical role in shaping their healthcare journey.

Throughput refers to the process of moving patients efficiently through the continuum of care, from admission to discharge. It’s a major concern for healthcare leaders and clinicians, directly impacting patient care, the length of hospital stays, and the overall efficiency of the healthcare system.

In recent years, throughput challenges have reached crisis levels, exacerbated by capacity constraints at acute care hospitals and skilled nursing facilities. This has led to delays in care, including prolonged emergency department wait times and delayed transfers to SNFs. Yet, despite these ongoing challenges, many inpatient rehabilitation facilities have the capacity to care for more patients than they currently serve.

By making informed, patient-tailored decisions about post-acute care, we can take immediate action to relieve the capacity crunch and streamline the patient journey toward recovery.

The root causes of the throughput crisis

Several factors contribute to this crisis. The global population has more than tripled since the mid-20th century, while the healthcare workforce has shrunk due to clinician retirements and burnout, particularly as the Boomer generation ages out of the workforce. These dynamics have created a significant capacity challenge, leading to longer wait times and barriers to accessing care among those who need it most.

At the same time, advances in medical science are allowing people to live longer with chronic, manageable conditions — many of which were once life-threatening. Acute care hospitals now focus on treating the sickest patients, while demand has surged for post-acute services that help transition patients from hospitals back home or into their communities.

However, the handoff between acute and post-acute care often creates a bottleneck in patients’ transition from the hospital, making it essential for healthcare providers to fully understand and utilize the full array of available post-acute care options.

Understanding the distinctions between SNFs and inpatient rehabilitation facilities

Both SNFs and IRFs are essential to the post-acute care continuum, providing residential rehabilitation services to help patients recover and transition out of the hospital. However, the distinctions between these two types of facilities are often misunderstood or overlooked, leading to inefficiencies in patient placement.

IRFs, for example, offer daily access to doctors and provide more intensive rehabilitation, with patients typically receiving three to four hours of therapy per day.

In contrast, SNFs often have more limited medical oversight, with daily access to nurses but not physicians, and typically provide only one to two hours of therapy per day. While SNFs are designed to help patients regain basic daily activities, IRFs are equipped to handle patients requiring more intensive rehabilitation, such as those recovering from traumatic brain injuries, amputations, or spinal cord injuries.

A new perspective: Leveraging IRFs to alleviate the crisis

One of the main contributors to the throughput crisis is the healthcare system’s overreliance on SNFs for inpatient post-acute care. As SNFs reach capacity, patients face long waits for beds, creating bottlenecks in hospitals as patients are held in inpatient units waiting for discharge. Often, these patients could be better served in an IRF, eliminating the need for SNF care altogether.

At Burke Rehabilitation, we treat some of the most complex conditions, yet 68% of our patients were discharged directly to their homes last year, continuing their recovery through outpatient services.

This highlights the potential of IRFs to not only manage high-acuity cases but also free up SNF beds, which are increasingly in high demand. By making better use of IRFs, we can relieve some of the pressure on both acute care hospitals and SNFs, helping to resolve the throughput bottleneck.

A collaborative path forward

One solution to the throughput crisis lies in education and collaboration across the healthcare continuum. Providers must be better educated on the distinct roles that SNFs and IRFs play in post-acute care, ensuring that patients are placed in the most appropriate setting for their care needs and recovery goals. With increased awareness and strategic use of all available resources, we can alleviate the capacity crisis, improve patient outcomes, and streamline the transition from acute care to post-acute recovery.

As part of the IRF community, I am confident that we are ready to partner with our colleagues in acute care and SNFs to ensure that every patient receives the highest level of care, achieves maximum functional recovery, and moves through the healthcare system as smoothly and efficiently as possible.

Scott Edelman is the executive director of Burke Rehabilitation Hospital, a member of Montefiore Health System.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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