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

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. Results: Outcomes are reported for the 2010/11 fiscal year, and compared with the two prior fiscal years. Mean LOS for individuals undergoing initial inpatient rehabilitation was 71.5 days for 2010/11, a 14 and 17% reduction compared with the 2008/09 and 2009/10 fiscal years, respectively. While LOS decreased, FIM change increased 9 and 16% compared with 2008/09 and 2009/10, respectively. Similarly, FIM efficiency increased 54 and 32% compared with 2008/09 and 2009/10. Conclusion: The use of benchmarking and decision support tools improved rehabilitation efficiency while increasing standardization in practice and transparency in LOS determination. Spinal Cord (2013) 51, 165-169; doi:10.1038/sc.2012.91; published online 31 July 2012