Outcomes of an accelerated discharge pathway after spinal fusion

Ms Sarah Temby1, Mr  Michael Johnson1, Associative Professor Bev Eldridge1

1The Royal Children’s Hospital, Parkville, Australia

Title:

Enhanced Outcomes Post Implementation of an Accelerated Discharge Pathway after Spinal Fusion.

Aim:

Improve outcomes for adolescents with an Idiopathic Scoliosis undergoing posterior spinal fusion.

Method:

An Accelerated Discharge Pathway (ADP) was introduced at The Royal Children’s Hospital (RCH) in January 2016 involving:

  • speedier transition to oral pain medication, drinking and eating
  • earlier removal of urinary catheter
  • earlier mobilization
  • discharge home without bowel movement.

Outcomes were measured via an audit of ADP patients in January to June 2016 (n = 19) compared with similar cohorts in 2013 (n = 17) and 2014 (n= 15) and patient satisfaction surveys (Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Hospital Survey).

Results:

No significant differences were found between patient demographic and surgical characteristics of the three patient groups.

The average length of hospital stay reduced post ADP implementation (3.4 days in January-June 2016) compared with pre-ADP (6.1 days in 2013; 6.5 days in 2014) resulting in cost reductions for nursing (38.4%), medical (72.2%) and allied health (31.5%).

The overall complication rate was low (0.05%) with 1 minor complication and no hospital readmissions.

 

The CAHPS Survey results post ADP implementation indicated satisfaction in multiple areas (where 100% represents maximum satisfaction):

  • 92.8% for communication with parent
  • 91.4% for communication with child
  • 85.2% for attention to safety and comfort
  • 92% global satisfaction rating

Significance of the findings to allied health:

Introduction of the ADP is the single biggest innovation in postoperative care of adolescents undergoing scoliosis surgery at RCH in the last 30 years. Findings indicate a significant impact on the patient management and reduction in costs without compromising patient safety and satisfaction.