Reduction of Inpatient Hospital Length of Stay in Lumbar Fusion Patients With Implementation of an Evidence-Based Clinical Care Pathway

STUDY DESIGN.Quality improvement with before and after evaluation of the intervention. OBJECTIVE.To improve lumbar spine post-operative care and quality outcomes through a series of Lean quality improvement events designed to address root causes of error and variation. SUMMARY OF BACKGROUND DATA.Lum...

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Bibliographic Details
Published in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 2017-02, Vol.42 (3), p.169-176
Main Authors: Bradywood, Alison, Farrokhi, Farrokh, Williams, Barbara, Kowalczyk, Mark, Blackmore, C. Craig
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Critical Pathways - statistics & numerical data
Female
Hospitals - statistics & numerical data
Humans
Inpatients
Length of Stay - statistics & numerical data
Lumbar Vertebrae - surgery
Male
Middle Aged
Patient Discharge - statistics & numerical data
Postoperative Care - statistics & numerical data
Quality Improvement
Spinal Fusion - adverse effects
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Summary:STUDY DESIGN.Quality improvement with before and after evaluation of the intervention. OBJECTIVE.To improve lumbar spine post-operative care and quality outcomes through a series of Lean quality improvement events designed to address root causes of error and variation. SUMMARY OF BACKGROUND DATA.Lumbar spine fusion procedures are common, but highly variable in process of care, outcomes, and cost. METHODS.We implemented a standardized lumbar spine fusion clinical care pathway through a series of Lean quality improvement events. The pathway included1) an evidence based electronic orderset; 2) a patient visual tool; and 3) multidisciplinary communication, and was designed to delineate expectations for patients, staff and providers. To evaluate the effectiveness of the intervention, we performed a quality improvement study with before and after evaluation of consecutive patients from January 2012 to September 2014. Outcomes were hospital length of stay and quality measures before and after the April 1, 2013 intervention. Data were analyzed with chi-square and t-tests for before and after comparisons, and were explored graphically for temporal trends with statistical process control charts. RESULTS.Our study population was 458 patients (mean 65 years, 65% female). Length of stay decreased from 3.9 to 3.4 days, a difference of 0.5 days (CI 0.3, 0.8, p 
ISSN:0362-2436
1528-1159
DOI:10.1097/BRS.0000000000001703