Standards for rehabilitation services

The provision of inpatient adult rehabilitation medicine services in public and private hospitals

These seven standards cover the aspects of rehabilitation medicine service provision.

Governance

A specialist rehabilitation medicine service primary objective of care is to help patients achieve their optimal level of functioning and participation in society.

Staffing

A patient's rehabilitation service is delivered by a range of medical, nursing, allied health and other staff team members, who have the appropriate skill base and training to provide care.

Facilities and equipment

Adequate and appropriate facilities and equipment are required for the rehabilitation needs of patients as well as provide a safe learning environment for retraining in lost skills.

Policies and procedures

Documented policies and procedures ensure rehabilitation patients are part of a safe, appropriate, accountable, effective and measurable process during their recovery.

Quality improvement and risk management activities

Rehabilitation services require a quality improvement and risk management framework that addresses consumer involvement, access and delivery of all treatment programs.

Education and training

All rehabilitation services must continue to be actively engaged in continued education, teaching and ongoing professional development.

Research

Actively promote and engage in the importance of research activities within your rehabilitation service.

The purpose of these standards is to guide RACP Fellows, government, health service planners and administrators in their decision making about the provision of inpatient adult rehabilitation medicine services in public and private hospitals. This document builds upon previous versions of The Australasian Faculty of Rehabilitation Medicine (AFRM) Standards documents and incorporates updated best practice and consensus guidelines into one single document, which can be used as a reference.

Application of the Standards

The AFRM is committed to the provision of comprehensive, high quality care in the services in which its Fellows practise. This document on Standards for Adult Rehabilitation Medicine Services in Public and Private Hospitals refers only to specialist rehabilitation medicine units. (In particular, it is stressed that these Standards do not refer to medical rehabilitation programs conducted by other physicians who are not specialists in rehabilitation medicine). The Standards do not apply to other restorative health or healthcare programs containing rehabilitation if they do not fulfil the criteria established by the AFRM for a specialist Rehabilitation Medicine service. See Demonstrating the Standards, Governance 1.2 – 1.8.

These Standards relate to the provision of inpatient rehabilitation programs only and are to be considered general standards. While also applicable to the provision of tertiary level, highly specialised, inpatient rehabilitation programs (for example, brain injury, spinal cord injury or burns rehabilitation), these tertiary rehabilitation programs may have requirements which are beyond the scope of this general Standards document.

For paediatric rehabilitation, see AFRM Standards for the provision of Paediatric Rehabilitation Medicine Inpatient Services in Public and Private Hospitals.

Application of the Standards in other rehabilitation settings

Rehabilitation medicine physicians also provide programs outside of traditional inpatient rehabilitation units (for example, in various community-based settings; as day hospital programs, or; in acute care settings such as an acute stroke unit or an ‘in-reach rehabilitation team’ providing rehabilitation services to patients within acute wards of the hospital). These Standards, while not designed specifically for use in these alternate settings, can nonetheless be used as a guide. Please refer to the AFRM Ambulatory Standards for further information on ambulatory rehabilitation medicine services.

Future development

Over time, it is the intention of the AFRM to develop Standards for use across a range of care settings and programs as newer service models become more established.

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References

AFRM Standards for provision of Paediatric Rehabilitation Medicine Inpatient Services In Public Private Hospital (2015)
Standards for the provision of Rehabilitation Medicine Services in the Ambulatory Setting (2014)
Rehabilitation Medicine: Advanced Training Curriculum, 1st edition; RACP (2010)
The Role of the Rehabilitation Physician (2008)
AFRM Rehabilitation Medicine Physicians Scope of Practice – Adult Rehabilitation Medicine
AFRM Rehabilitation Medicine Physicians Scope of Practice – Paediatric Rehabilitation Medicine
Kwakkel G, Wagenaar RC, Koelman TW, Lankhorst GJ, Koetsier JC (1997). Effects of intensity of rehabilitation after stroke. A research synthesis. Stroke, 28(8), 1550-1556.
Teasell R, Bitensky J, Salter K, Bayona N (2005). The Role of Timing and Intensity of Rehabilitation Therapies. Top Stroke Rehabil. Summer;12(3):46-57
Jette D, Warren R, Wirtalla C (2005). The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities. Arch Phys Med Rehabil. 86(3):373-9.
Evidence-Based Review of Stroke Rehabilitation. Heart and Stroke Foundation, Canadian Partnership for Stroke recovery http://www.ebrsr.com/evidence-review/6-elements-stroke-rehabilitation
Standards for the Accreditation of Rehabilitation Medicine Training Settings
Poulos, C. (2010). Evaluating inpatient public rehabilitation in Australia using a utilization review tool developed in North America. Journal of Rehabilitation Medicine, 42 (3), 246-253
Scrivener K, Jones T, Schurr K, Graham PL, Dean CM (2015). After-hours or weekend rehabilitation improves outcomes and increases physical activity but does not affect length of stay: a systematic review.
Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF (2013). Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial. BMC Medicine.
Rehabilitation medicine physicians delivering integrated care in the community - Early Supported Discharge programs in stroke rehabilitation: an example of integrated care. March 2018
Rehabilitation Medicine Version 6: Clinical Indicators User’s Manual. Clinical Indicator Program, The Australian Council on Healthcare Standards

Acknowledgements

The RACP would like to acknowledge and thank the Inpatient Standards Reference Group members for who led this work:

Professor Tim Geraghty, Chair
Dr Cynthia Bennett
Dr John Estell
Dr Pesi Katrak
Dr Maria Paul
Dr Angela Wills

We also acknowledge and thank the Australasian Faculty of Rehabilitation Medicine (AFRM) Policy and Advocacy Committee and Council for their contribution.

The AFRM is grateful to Allied Health Professions Australia and other professional groups for their comments on this document.

The development of the Standards was supported by Anastasia Barabash, AFRM Executive Officer and Renata Houen, Policy and Advocacy Officer.