Oral Presentation Asia Pacific Stroke Conference 2024

Analysis of the greenlight initiative – a method of streamlining transfer of patients from the acute stroke unit to inpatient rehabilitation (106570)

Peishan Cai 1 , Karen Stephenson 2 , Jane D’Souza 2 , Louisa Soh 3 , Emily Schembri 4 , Philip Choi 2 4
  1. School of Medicine, Deakin University, Geelong, Victoria, Australia
  2. Department of Neuroscience, Box Hill Hospital, Box Hill, Victoria, Australia
  3. Rehabilitation Medicine, Eastern Health, Burwood East, Victoria, Australia
  4. Faculty of Medicine, Nursing and Health Sciences, Eastern Health Clinical School, Clayton, Victoria, Australia

Background:

One of the barriers to timely transfer of patients from the acute stroke unit for inpatient rehabilitation (IPR) may be the time waiting for a formal rehabilitation physician review. The Greenlight initiative is a criteria-led method for staff to activate transfer without formal involvement from the receiving rehabilitation unit.

Aim:

We aimed to determine the length of stay (LOS) post greenlight and factors associated with longer wait for subacute transfer.  

Methods:

A single centre retrospective analysis of all patients successfully transferred to IPR in 2023 at a high volume metropolitan primary stroke centre was conducted. Clinically significant events are defined as events that would normally require a transfer back to the acute facility such as new onset seizures, chest pain and aspiration pneumonia.

Results:

179 of the 316 patients transferred to IPR were referred via the greenlight pathway. Patients had a median age of 80 IQR (71,85), NIHSS of 5 IQR (3,9), a premorbid mRs of 1 IQR(1,3) and median LOS was 3 days IQR (1, 5) post greenlight with 27% of the patients waited one day or less and 15% waited for one week or more. 6.7% of patients had a clinically significant event prior to transfer. Haemorrhagic stroke (n=41) (β 2.2); 95% CI 1.055, 3.350; p<0.001) was associated with longer wait post greenlight in a multivariable regression model.

Conclusion:

Over half of all acute stroke patients transferred for IPR benefited from the greenlight pathway. Just over one quarter waited one day or less post activation.