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Background Patient flow is a major problem in hospitals. Delays in accessing inpatient rehabilitation have not been well studied. Aims Measure the time taken for key processes in the patient journey from acute hospital admission through to inpatient rehabilitation admission in order to identify opportunities for improvement. Methods Retrospective open cohort study. All patients admitted over 8- and 10-month periods during 2008 into two inpatient rehabilitation units in Melbourne, Australia. Main outcome measures were the duration of the following key processes: acute hospital admission until referral for rehabilitation, referral until assessment by the rehabilitation service, assessment until deemed ready for transfer to rehabilitation, ready for transfer until rehabilitation admission. Results Three hundred and sixty patients were in the study sample (females = 186; 51.7%); mean age = 58.4 (standard deviation = 15.0) years. There was a median of 7 (interquartile range [ IQR] 4-13) days from acute hospital admission till referral for rehabilitation, a median of 1 ( IQR 0-1) day from referral till assessment, a median of 0 ( IQR 0-2) days from assessment till deemed ready for transfer and a median of 1 ( IQR 0-3) day from ready till admission into rehabilitation. Overall, patients spent 12.0% (804/6682) of their acute hospital admission waiting for a rehabilitation bed. Conclusions There are opportunities to improve the efficiency of key processes in the acute hospital journey for patients subsequently admitted to inpatient rehabilitation; in particular, reducing the time from acute hospital admission till referral for rehabilitation and from being deemed ready for transfer to rehabilitation till admission. [ABSTRACT FROM AUTHOR]

Background Population ageing is projected to impact on health services utilisation including Emergency Departments ( ED), with older patients reportedly having a high rate of return visits. We describe and compare patterns in ED utilisation between older and younger adults, and quantify the proportion and rate of return visits. Methods Population-based retrospective analysis of metropolitan Melbourne public hospital ED data, 1999/2000 to 2008/2009. Numbers of patients, presentations, re-presentations and rates per 1000 population were calculated, with comparison of older (aged ≥70 years) and younger (15-69 years) attendances. Results Population growth in each age group was similar over the study period, yet ED presentations rose by 72% for older adults compared with a 59% increase for younger adults. Rates per 1000 population rose with increasing age. Of the population aged ≥70 years, 39% presented to ED compared with 17% of the population aged 15-69 years in 2008/2009. Twenty-seven per cent of the increase in older adult presentations was driven by a cohort who attended ≥4 times in 2008/2009. The number of older patients presenting ≥4 times doubled over the decade, contributing to 23% of all older presentations in 2008/2009. ED length of stay rose with increasing age; 69% of older adults remained in ED for ≥4 h compared with 39% of younger adults in 2008/2009. The number of older adult ED hospital admissions doubled over the decade. Conclusions Older patients are disproportionately represented among ED attendances. They also have an increasing propensity to re-present to ED, indicating a need to identify the clinical, social and health system-related risk factors for re-attendance by specific patients. [ABSTRACT FROM AUTHOR]