Purpose: Nurse leaders aimed to determine if the implementation of a centralized spinal orthoses program on a post-surgical unit would reduce the cost associated with spinal orthoses, promote early ambulation of post-operative spinal patients, and reduce patients’ length of stay in hospital.
Background: Millions of individuals globally, injure their thoracic and lumbar spine through trauma e.g., sports injuries, automobile accidents, falls, etc. Injury to the spine can lead to significant disabilities that require costly medical interventions. At a minimum, most physicians require immobilization of the spine with a thoracic lumbar-sacral orthosis (TLSO) and lumbar-sacral orthosis (LSO) before a patient can ambulate (Burgess & Wainwright, 2019). At this level II trauma hospital, TLSO and LSO are supplied through an external vendor. In 2018, nurse leaders identified various disadvantages associated with using an external vendor’s delivery of off-the shelf (OTS) spinal orthoses. These include high hospital costs, patient charges, delay in ambulation of post-operative patients, and an increase in length of stay. Hospital data analyzed in 2019 revealed that the hospital spent over $500,000 on braces and orthotics. Back braces cost patients between $1,500 and $1,770. Since orthotics are not considered chargeable items, they are not reimbursed by insurance companies. Instead, they are included in the room charge that goes directly to patients. Utilizing an external vendor required several steps which often resulted in delays in early ambulation. Inpatient days were also extended to facilitate the fitting and delivery of orthosis.
Methods: The centralized management of OTS spinal orthoses included in-house stocking three adjustable TLSO and LSO sizes. Nurses received training to fit the orthosis to patient properly. This study used a retrospective interrupted time-series design to compare outcomes pre and post program implementation. Outcome measurement included time to first ambulation/mobilization, length of stay, and spinal orthoses cost savings. Shapiro-Wilk tests, Wilcoxon rank sum test, and Fisher’s exact test were used to compare outcome measures pre- and post-implementation of the centralized program.
Results: The nurse-driven program cost savings equated to a cost of $287 for a thoracic lumbar-sacral orthosis and $257 for a lumbar-sacral orthosis in comparison to $1770 for a thoracic lumbar-sacral orthosis and $1584 for a lumbar-sacral orthosis under the vendor program. Statistical testing identified a trend toward a statistically significant reduction in length of stay (p=0.063; median shift: -0.78 days [95% CI: -1.34 to 0.02 days]) and a statistically significant reduction in time to mobilization from admission (p=0.004; median shift: -3.85 hours [-7.26 to -1.27 hours]) for patients managed under the centralized program.
Conclusion: The nurse-driven centralized program resulted in overall cost savings for the patients and the hospital. The program also significantly improved quality care for patients that required a spinal orthosis, by promoting early ambulation, allowing timely discharge for a reduction in hospital length of stay.
Evidence-based references 1. Burgess, L. C., & Wainwright, T. W. (2019). What Is the Evidence for Early Mobilisation in Elective Spine Surgery? A Narrative Review. Healthcare (Basel, Switzerland), 7(3), 92. https://doi.org/10.3390/healthcare7030092