Sub-Acute Care

Sub-acute care occupies the clinical interval between intensive hospital treatment and long-term rehabilitation or community living. It encompasses multidisciplinary rehabilitation, medical oversight and psychosocial support delivered in specialised units, skilled nursing facilities or through home-based programmes. A core aim is to restore function and independence after acute events—such as stroke, surgery or serious illness—while preventing complications and avoiding unnecessary hospital readmission. Sub-acute services integrate physiotherapy, occupational therapy, speech and language therapy, nursing care and medical review, underpinned by individualised care plans. Modern approaches emphasise early mobilisation, standardised assessment tools to gauge functional trajectories, and seamless transitions across care settings. Increasingly, digital monitoring, telehealth consultations and hospital-at-home models extend sub-acute services into patients’ residences. Globally, the focus has shifted towards person-centred models that address not only physical recovery but also emotional well-being, cognitive function and social reintegration. Outcomes—measured by functional gains, reduced length of stay and lower readmission rates—underscore the practical and economic value of robust sub-acute care pathways.

Research from Nature Portfolio

A large register-based analysis in Sweden compared planned rehabilitation referrals at hospital discharge in 2011 and 2017. Over 35 000 stroke patients were assessed, revealing an increase in scheduled sub-acute rehabilitation from around 57 per cent to 72 per cent of discharges. Severe neurological impairment and impaired consciousness strongly predicted referral, whereas community and non-university hospitals lagged behind university centres. These findings highlight the importance of institutional factors in ensuring equitable sub-acute care access and point to the need for standardised referral pathways to reduce variability across regions and hospital types.

Research from all publishers

A recent handbook chapter on transitional and intermediate care maps the continuum of sub-acute services, spanning rapid-response pathways, hospital-at-home programmes, home-based reablement and step-up/step-down beds in community hospitals or care homes. Synthesis of international studies indicates that interdisciplinary teams delivering comprehensive geriatric assessment at home or in sub-acute units achieve improved functional ability, lower healthcare costs and reduced hospital readmissions, particularly when rehabilitation is tailored to patient-defined goals.

A scoping review protocol on telerehabilitation safety has drawn attention to the growing use of digitally delivered exercise and therapy in the post-acute period. It emphasises the need for systematic reporting of risk-mitigation strategies—such as fall-prevention protocols, remote monitoring and clear adverse-event management plans—to ensure safe delivery of sub-acute interventions outside traditional clinical settings.

Analysis of rehabilitation assessment in over 11 000 Chinese patients following subarachnoid haemorrhage revealed that 58 per cent underwent formal sub-acute assessment. Longer hospital stays, stroke unit admission and standardised screening for dysphagia and thrombosis were associated with higher assessment rates. Marked variations among hospital grades and a strong link between assessment and subsequent discharge to specialised rehabilitation facilities underscore the critical role of early, systematic evaluation in optimising sub-acute care pathways.

Sub-Acute Care publication trend

The graph below shows the total number of articles in sub-acute care across all publications each year (not limited to Nature Index journals).

Technical terms

Sub-acute care: Multidisciplinary services provided between acute hospital treatment and long-term rehabilitation or community discharge.

Transitional care: Organised processes to ensure continuity of healthcare as patients move between settings.

Intermediate care: Short-term, community-based support—often in patients’ homes or community hospitals—focusing on recovery and functional restoration.

Reablement: Strength-based, time-limited programmes that help individuals regain daily living skills and autonomy after illness or injury.

Telerehabilitation: Remote delivery of therapeutic interventions via digital communication technologies.

Hospital-at-home: Provision of acute or sub-acute hospital-level care in a patient’s residence, using multidisciplinary teams and monitoring tools.

References

1. A register-based study comparing planned rehabilitation following acute stroke in 2011 and 2017. Scientific Reports (2021).
2. Transitions of Care.
3. Considerations for ensuring safety during telerehabilitation of people with stroke. A protocol for a scoping review. PLOS ONE (2023).
4. Assessment of rehabilitation following subarachnoid haemorrhage in China: findings from the Chinese Stroke Center Alliance. BMC Neurology (2023).