Rehabilitation medicine in the acute care setting in Japan.

In Japan, restorative rehabilitation units were introduced into the healthcare system in 2000. This policy brought structural changes to our inpatient medical services. Three types of medical facilities -namely, acute care hospital, restorative rehabilitation hospital, and chronic care hospital - are now clearly differentiated according to the health condition of inpatients and the medical procedures the facility provides. Developing medical rehabilitation services in acute care hospitals is a challenging task because of the shortage of the time to treat the patients to such an extent. In recent years, the mean length of stay in acute care hospitals per patient has been about 2 weeks. Acute care physicians also have to be careful about delivering rehabilitative interventions because the patients' medical conditions are often too complicated and too critical to undergo sufficient medical rehabilitation. Consequently in acute care hospitals, the role of a medical rehabilitation team, which includes a physiatrist (physician specialized in rehabilitation medicine), physical therapist, occupational therapist, and speech pathologist, is to properly evaluate patients and deliver safe, effective, and efficient rehabilitative intervention. Moreover, for some patients who need long-term intensive care (severe traumatic brain injury, cerebrovascular accident with multiple comorbidities, cervical cord injury, multiple injury, etc.), we have to make exceptions and deliver intensive long-term rehabilitation care in acute care hospitals. Medical rehabilitation in the acute care setting is a challenging yet essential mission for providing high quality medical care.