Decreasing Length of Stay in Elective Neurosurgery: Success of a Quality Improvement Initiative

This article describes the design, implementation, and results of a longitudinal multidisciplinary quality improvement (QI) initiative to improve length of stay (LOS) in elective neurosurgical patients at an academic satellite hospital.

LOS was measured on a per-patient basis using an individualized LOS index (LOSI), defined as an observed-to-expected LOS ratio. Interventions were identified and implemented using QI methodology, and results were tracked in real time using Shewhart control charts over a 12-month period. Bimonthly meetings with a multidisciplinary working group enabled continuous and iterative development, review, and implementation of effective interventions. Notable interventions include standardizing electronic health record (EHR) order sets to include Enhanced Recovery After Surgery (ERAS) components; standardizing physical therapy, social work, and case management processes; streamlining radiology workflows; and standardizing interdisciplinary communication.

The initiative led to a sustained reduction in LOSI, with several consecutive months surpassing the institutional target of < 1, accomplishing the project's primary aim. Furthermore, at the completion of the project there was a statistically significant improvement in LOSI from the pre- to postintervention groups (1.13 vs. 0.93, p = 0.033).

This initiative demonstrates that longitudinal, multidisciplinary QI efforts based on real-time analysis and data-driven adjustments can lead to impactful, sustained reductions in LOS for elective neurosurgical patients. The initiative provides a sustainable and adaptable framework that may serve as a model for other institutions seeking to improve perioperative efficiency and patient care outcomes.