Implementing an Interdisciplinary Order Set for Amputation: A Cross-Sectional Quality Improvement Study

Area of Science:

• Health Services Research
• Quality Improvement Science
• Clinical Informatics

Background:

• Standardizing interdisciplinary care coordination for lower extremity amputation patients is crucial for optimal outcomes.
• Electronic Medical Record (EMR) systems offer potential for streamlining care pathways.
• A novel EMR-based order set was developed to address care coordination gaps.

Purpose of the Study:

• To evaluate a novel EMR-based order set designed to standardize interdisciplinary care coordination for lower extremity amputation.
• To assess the impact of the order set on consultation patterns, length of stay, and discharge disposition.

Main Methods:

• A quality improvement study comparing patients with and without the amputation order set (n=637).
• Analysis of interdisciplinary consultation patterns, length of stay (LOS), and discharge disposition.
• Utilized an EMR system to implement and track the order set's usage.

Main Results:

• The order set significantly increased consultations with Physical Medicine and Rehabilitation (PM&R), chaplaincy, and orthotics/prosthetics.
• While overall LOS was longer, preoperative order set use led to a significantly shorter time from surgery to discharge.
• Patients using the order set were more likely to be discharged to inpatient rehabilitation facilities.

Conclusions:

• Structured, preoperative interdisciplinary coordination enhances discharge planning and facilitates higher-quality rehabilitation.
• EMR-integrated standardized consultation panels improve provider adoption and access to care.
• This quality improvement initiative demonstrates the value of technology in optimizing amputation care pathways.