Reducing process barriers in acute hospital for spinal cord damage patients needing spinal rehabilitation unit admission

Abstract

Objectives:

To identify opportunities for improvement by recording duration of key processes from acute hospital admission until spinal rehabilitation unit (SRU) admission.

Setting:

SRU, Victoria, Australia.

Methods:

Consecutive referrals of patients with recent spinal cord damage had prospective documentation of the key clinical and demographic characteristics and duration (days) of the following sequential discrete processes: acute hospital admission until referral to SRU, referral until SRU assessment, SRU assessment until ready for transfer to SRU and ready for transfer until SRU admission.

Results:

A total of 347 patients were referred with median age (interquartile range (IQR)) of 65 (52–76) years. Most patients were male (n=203, 58.5%), had paraplegia (n=267, 77%) and an aetiology due to spinal cord myelopathy (n=280, 80.7%). There was a median of 12 days (IQR 6–20) from acute hospital admission until referral, a median of 1 day (IQR 0–2) from referral till assessment, a median of 0 (IQR 0–3.5) days from assessment till deemed ready and a median of 7 (IQR 2–20) days from deemed ready until transfer to SRU. Overall, patients spent 34.2% (4951/14 478 days) of their acute hospital length of stay waiting for a SRU bed.

Conclusions:

There are opportunities to improve the efficiency of the acute hospital journey for patients referred to a SRU. The biggest opportunities exist for reducing the time from acute hospital admission till referral to SRU and the time from deemed ready for transfer to SRU till admission.