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

Abstract

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.

A simplified clinical prediction rule for prognosticating independent walking after spinal cord injury: a prospective study from a Canadian multicenter spinal cord injury registry

“…Standard follow-up measurements to assess long-term outcomes are conducted at 1 year post injury [11,21] by which time neurologic and functional outcomes are known to plateau [22][23][24][25][26]. Thus, we used the first FIM locomotion assessment that was available ≥12 months post injury as the outcome measure for independent ambulation.…”

Documenting Routinely What Matters to People: Standardized Headings for Health Records of Patients with Chronic Health Conditions

“…For instance, interventions can be allocated tailored to the specific health and related issues of a person in need of services through risk stratification and predictive-modeling algorithms. 46 Work and communication flows can be easily coordinated based on aspects most relevant to patients, which is of great value particularly where people receive care from various professionals across many settings. Additionally, compliance with organizational processes and their outcomes can be audited.…”

Spinal Cord Essentials: the development of an individualized, handout-based patient and family education initiative for people with spinal cord injury

“…Shorter rehabilitation lengths of stay 26 reduce opportunities for teachable moments and increase the likelihood of patients being discharged before having acquired important knowledge and skills to prevent secondary health complications. 5,6 It is therefore imperative that patient and family education be delivered efficiently and effectively.…”