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Reducing Postoperative Length of Stay for Idiopathic Scoliosis Patients using Quality Improvement Methodology
Crystal Seilhamer1, Kelly Miller1, Jessica Holstine2
1From the Center for Comprehensive Spine Care, Department of Orthopedics, Nationwide Children's Hospital, Columbus, Ohio.
Insights
This quality improvement initiative successfully reduced hospital length of stay (LOS) for idiopathic scoliosis patients undergoing posterior spinal fusion. Standardized care pathways and improved pain management significantly decreased average LOS, enhancing patient recovery.
Area of Science:
- Orthopedic Surgery
- Quality Improvement
- Pediatric Healthcare
Background:
- Scoliosis affects 1%-3% of the US population, with 80% being idiopathic scoliosis.
- Approximately 10% of idiopathic scoliosis patients require surgical intervention, specifically posterior spinal fusion.
- The institution's length of stay (LOS) for these patients exceeded peer institutions, indicating a need for improvement.
Purpose of the Study:
- To reduce the length of stay (LOS) for patients undergoing posterior spinal fusion for idiopathic scoliosis.
- To improve discharge rates within 4 days post-procedure from 39.13% to a target of 90%.
Main Methods:
- Implementation of a new pain management protocol.
- Introduction of a daily patient-focused checklist for providers and families.
- Enhanced patient and family education on postoperative pain expectations.
- Updated electronic order sets for streamlined care.
Main Results:
- Achieved a discharge rate of 93.48% within 4 days, significantly exceeding the 90% target.
- Reduced the average post-procedure LOS from 4.93 days to 2.59 days.
- Increased the percentage of patients off patient-controlled analgesia by postoperative day 2 from 13% to 97.75% without impacting readmissions or ED visits for pain.
Conclusions:
- A standardized care pathway, including a patient-focused checklist and updated pain management, effectively reduced LOS for idiopathic scoliosis patients.
- Established clear expectations for LOS and pain management, leading to improved patient outcomes.
- The initiative demonstrated successful quality improvement in managing postoperative care for spinal fusion patients.
Abstract:
Approximately 1%-3% of the US population is diagnosed with scoliosis. In addition, 80% of those diagnosed have idiopathic scoliosis, with about 10% requiring surgical intervention. This Quality Improvement initiative aimed to reduce the length of stay (LOS) after posterior spinal fusion for these patients. According to the Pediatric Health Information System, our institution had a poorer performance, with an actual LOS greater than or equal to the expected LOS compared with peer institutions.
Methods:
The aim was to increase the percentage of idiopathic scoliosis patients with a procedure to discharge LOS of less than or equal to 4 days after posterior spinal fusion from 39.13% to 90%. Interventions included implementing a new pain management protocol, a daily checklist, education on expectations of postoperative pain, and updated order sets.
Results:
Interventions improved patients discharged in less than 4 days from 39.13% to 93.48% (P ≤ 0.001), reducing the average postprocedure LOS from 4.93 to 2.59 (P ≤ 0.001) days. A key process measure tracked was the percentage of patients off the patient-control analgesia pump by postoperative day 2, which increased from 13% to 97.75% (P ≤ 0.001). These improvements did not affect the balancing measure of readmissions or Emergency Department visits for pain.
Conclusions:
By implementing a more standardized pathway, including a patient-focused daily checklist for providers and families, we established expectations for LOS and pain. This checklist and updates to the pain management protocol successfully reduced the length of stay in idiopathic scoliosis patients after posterior spinal fusion.
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