Impact of benchmarking and clinical decision making tools on rehabilitation length of stay following spinal cord injury

Study design: Performance improvement initiative. Objectives: To improve efficiency of spinal cord rehabilitation by reducing length of stay (LOS) while maintaining or improving patient outcomes. Setting: Academic hospital in Canada. Methods: LOS benchmarking was completed using national comparator...

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Bibliographic Details
Published in:Spinal cord 2013-02, Vol.51 (2), p.165-169
Main Authors: Burns, A S, Yee, J, Flett, H M, Guy, K, Cournoyea, N
Format: Article
Language:English
Subjects:
631/378/1687/1825
692/700/228/491
Anatomy
Benchmarking - methods
Biomedical and Life Sciences
Biomedicine
Canada
Census
Communication
Data collections
Data processing
Decision making
Decision Support Systems, Clinical
Hospitals
Human Physiology
Humans
Length of Stay
Neurochemistry
Neuropsychology
Neurosciences
original-article
Rehabilitation
Rehabilitation Centers
Spinal Cord Injuries - rehabilitation
Spinal cord injury
Standardization
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Summary:Study design: Performance improvement initiative. Objectives: To improve efficiency of spinal cord rehabilitation by reducing length of stay (LOS) while maintaining or improving patient outcomes. Setting: Academic hospital in Canada. Methods: LOS benchmarking was completed using national comparator data from the Canadian Institute for Health Information (CIHI). Clinical decision-making tools were developed to support implementation and sustainability. A standardized ‘tentative discharge date’ calculator was created to establish objective LOS targets. Defined discharge criteria and an accompanying clinical decision tree were developed to support team decision making and improve transparency. A revised patient census tool was also implemented to improve team communication and facilitate data collection. The initiative was implemented in March 2010 and the following metrics were evaluated: LOS, Functional Independence Measure (FIM) change and FIM efficiency. Results: Outcomes are reported for the 2010/11 fiscal year, and compared with the two prior fiscal years. Mean LOS for individuals undergoing initial inpatient rehabilitation was 71.5 days for 2010/11, a 14 and 17% reduction compared with the 2008/09 and 2009/10 fiscal years, respectively. While LOS decreased, FIM change increased 9 and 16% compared with 2008/09 and 2009/10, respectively. Similarly, FIM efficiency increased 54 and 32% compared with 2008/09 and 2009/10. Conclusion: The use of benchmarking and decision support tools improved rehabilitation efficiency while increasing standardization in practice and transparency in LOS determination.
ISSN:1362-4393
1476-5624
DOI:10.1038/sc.2012.91