ABSTRACT
Treatment in hospitals differs from treatment in rehabilitation centers from a legal perspective because German law mandates that in hospitals physicians and other qualified personnel must be on duty at all times. This is not required for inpatient rehabilitation centers. Since this Act was passed more than 30 years ago, more acute medical interventions are now carried out and the number of older people in the population has increased. As a result patients are nowadays older, more multimorbid and therefore have a greater risk for medical complications. This is especially true for postacute neurological care. For this reason, the original legal framework for neurological rehabilitation treatment has become questionable. Therefore, we prospectively tested how often patients in inpatient neurorehabilitation suffer from complications that require immediate attention by qualified personnel. In 759 patients observed over a period of 6 months we found 602 complications requiring immediate interventions by physicians (e.g. falls, urinary tract infections, other forms of fever, diarrhea associated with Clostridium difficile, pneumonia, respiratory insufficiency, sepsis, epileptic seizures and arrhythmia). On average at least three acute care interventions occurred per day at the facility examined. We conclude that neurological inpatient rehabilitation has outgrown its legal foundations and now incorporates hospital care.
