Impact of the physical therapy–managed spinal orthoses program on cost of care in the hospital setting: a retrospective interrupted time-series study

Abstract

Background The physical therapy department at a level 1 trauma center identified vendor delivery delays of off-the-shelf (OTS) spinal orthoses that delayed patient mobilization. This study aimed to identify improvements in mobilization times, discharge times, and reduction in the cost of care after centralizing the management of orthoses within the therapy department. Methods The centralized management of OTS spinal orthoses included stocking three adjustable lumbosacral and thoraco-lumbosacral orthosis sizes and ensuring all personnel received training to appropriately fit the orthoses to patients. This study evaluates the impact of the centralized program by using a retrospective interrupted time-series design to compare outcomes before and after program implementation. Outcome measurements included orthosis delivery delay, time to orthosis delivery, time to mobilization by physical therapist, length of stay, and cost of care. Segmented linear regression, Wilcoxon rank-sum test, and Fisher Exact tests compared outcome measures before and after implementing the centralized program. Results The physical therapy managed program eliminated orthosis delivery delays noted during the vendor program (42 vs. 0; p < 0.001), resulting in an overall 13.97 hr. reduction in time to mobilization (p < 0.001). Program cost savings equated to $2,023.40 per patient (P < 0.001). Sub-group analysis of patients without complications and treated conservatively showed a significant reduction in length of stay (15.36 hrs.; p = 0.009) in addition to time to mobilization reductions. Conclusions The physical therapy managed program significantly improved the quality of care for patients that required a spinal orthosis by mobilizing patients as soon as possible, allowing timely discharge. The program also resulted in overall patient and hospital cost savings.

Reducing costs and improving patient recovery through a nurse-driven centralized spinal orthoses program on a post-surgical unit: A quality improvement initiative

“…When considering only patients who did not experience a complication, this study identified a reduced length of stay for patients managed under the centralized program. These observations agree with findings previously reported in the literature that show early ambulation with a spinal orthotic can help to decrease a patient's length of stay ( Hoyer et al, 2016 ; Stethen et al, 2018 ; Willey et al, 2022 ). A reduction in the number of inpatient days results in decreased risk of infection and medication side effects, improvement in the quality of treatment, and increased hospital profitability margins with more efficient bed management ( Baek et al, 2018 ; Horn et al, 2018 ; Lakomkin and Hadjipanayis, 2017 ).…”

“…While a possibility, the risk of such an occurrence is equally distributed between the two study groups. While risks of bias are always present in retrospective studies, the results reported from this study are similar to those of comparable studies ( Hanson et al, 2019 ; Willey et al, 2022 ). This study also did not evaluate patients managed conservatively with only an orthosis; however, the observed improvements in time to mobilization and length of stay following surgery likely extend to patients managed conservatively.…”

“…The researchers found that brace-associated costs decreased significantly ($1352.41 versus $3719.53, respectively) ( Hanson et al, 2019 ). A similar study led by physical therapists to centralize the process of fitting and providing off-the-shelf orthotics found a cost savings of $2023.40 per patient, in addition to shorter times to ambulation and lengths of stay ( Willey et al, 2022 ). These cost savings per patient are similar to the $1921.20 identified in the current study.…”

“…Before the program, the hospital admitted these patients while they waited for the vendor to bring an orthosis. This process change helps free up beds in the ED, increasing throughput and preventing unnecessary bed occupancy, improving healthcare utilization ( Edwards et al, 2017 ; Willey et al, 2022 ).…”

“…Historically, an orthotist would graft a custom spinal orthosis for each patient leading to a costly expense for spinal injury patients; however, with the advent of off-the-shelf orthotics, an orthotic pre-manufactured in different sizes and adjusted to fit the patient at the time of use to provide the same immobilization as a custom orthotic, provides an alternative. Orthotic vendors commonly provide both custom and off-the-shelf orthotics; however, recent studies demonstrate that hospitals can realize significant cost savings and eliminate delays in care by providing off-the-shelf spinal orthotics directly to their patients ( Hanson et al, 2019 ; Willey et al, 2022 ).…”