Incidents and Sudden Patient Deteriorations Occurring During Their Rehabilitation Sessions in an Acute Care Hospital: A Retrospective Cohort Study

Objective: To investigate the occurrence of incidents and sudden deteriorations during rehabilitation in an acute care setting by disease category based on the International Classifi-cation of Diseases and Related Health Problems, 10th Revision. Design: Retrospective cohort study. Setting: University hospital in Japan with 1376 beds. Participants: A total of 49,927 patients who were admitted to the acute care wards and underwent rehabilitation over 8 years, from April 1, 2013, to March 31, 2021. Interventions: Rehabilitation in an acute care setting. Main Outcome Measures: Incidents and sudden deteriorations reported in medical charts. Results: Among 49,927 admissions, 455 incidents and 683 sudden deteriorations occurred during rehabilitation. The incidents and sudden deteriorations occurred at rates of 0.009/person (0.50 case/1000 h) and 0.012/person (0.75 case/1000 h), respectively. The 3 most frequent incidents were "route-related incidents" (178 cases, 39.1%), followed by "bleeding/abrasions" (131 cases, 28.8%) and "falls" (125 cases, 27.5%). Among 12 disease categories with over 500 admissions and 10,000 rehabilitation hours, the highest incident rate occurred in "certain infectious and parasitic diseases" (0.81 case/1000 h), followed by "diseases of the musculoskeletal system and connective tissue" (0.67 case/1000 h) and "diseases of the genitourinary system" (0.66 case/1000 h). The commonest sudden deterioration was "vomiting" (460 cases, 67.3%), followed by "decreased level of consciousness (with reduced blood pressure)" (42 cases, 6.1%) and "seizure" (39 cases, 5.7%). Furthermore, the highest sudden deterioration rate was in the "endocrine, nutritional, and metabolic diseases" (1.19 case/1000 h) category, followed by "neo-plasms" (1.04 case/1000 h) and "certain infectious and parasitic diseases" (0.99 case/1000 h). Conclusions: An incident and sudden deterioration occurred every 2000 and 1333 h, respectively, during rehabilitation. Therefore, understanding the actual occurrence of incidents and sudden deteriorations during rehabilitation may provide valuable insights into preventing incidents and emergencies.(c) 2023 The Authors. Published by Elsevier Inc. on behalf of American Congress of Rehabilitation Medicine. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/).