Time use of stroke patients in three rehabilitation hospitals.

The active role of the patient in the rehabilitation hospital requires the efficient use of patient time. Previous work has found that such patients spend a relatively small portion of their day in treatment. In this study 63 stroke patients in three hospitals were observed for two work days each. Fifty observations were made during each day of the patient's location, activity and whom the patient was with. Treatment occupied an average of 31% of the day. Passive behavior took up 42% of patients' time. Discriminant analysis showed that patients in the hospital with a separate stroke unit spent more time in treatment. In spite of quantitative differences, the three hospitals had similar patterns of treatment activity and deployment of staff. Clinical norms for the treatment of stoke across the three hospitals resulted in similar treatment experiences for patients. A system of prospective payment which did not require specific billed treatment hours might allow more flexibility and efficiency in this type of specialty hospital.