Length of Stay Initiative by Drs. Harrington and Horton Featured on ABPMR Website
July 30, 2024
A length of stay initiative for the spinal cord injury unit at UPMC Mercy, developed by Amanda Harrington, MD, and John Horton III, MD, assistant professors, University of Pittsburgh Department of Physical Medicine & Rehabilitation, was a featured “exemplary quality improvement project” by the American Board of Physical Medicine and Rehabilitation (ABPMR).
Having observed that the actual length of stay on the inpatient SCI unit was substantially longer than the estimated length of stay, the team aimed to reduce the average length of stay on the unit without worsening other outcomes, such as rates of discharge into the community, changes in self-care, and changes in functional mobility. The length of stay initiative was observed in six-month intervals.
According to the feature, multiple factors likely contributed to the discrepancy in length of stay. Often, the initial data for estimated length of stay is not available to the team at the time of the initial team conference, thus a target discharge date is determined prior to having necessary data to help inform the length of stay decision.
The team implemented the length of stay initiative on the inpatient rehabilitation unit through a team education session. By making all team members (physicians, nurses, therapists, and discharge case managers) aware of the problem, the team could implement specific strategies to combat the problem, including:
- Deciding not to select a target discharge date until estimated length of stay data was available to review in the team conference.
- Utilizing the estimated length of stay data during the team conference in order to set a target discharge date which would be more reflective of expected outcomes.
- Educating patients and families that the discharge date may change if patient goals were achieved early, a plateau in function was observed, or if the discharge disposition changed to skilled nursing facility.
- Modifying length of stay by a few days rather than by an entire week if deciding to extend a patient’s length of stay beyond their target discharge date.
The feature highlights that after the first six months, the team was able to reduce the average observed (actual) length of stay on the inpatient rehabilitation unit. Reduction in length of stay did not have a negative impact on other important outcome measures on the unit.
The team intends to complete the re-education every six months to maintain the success of this project.
About Dr. Harrington
Dr. Harrington is an assistant professor in the University of Pittsburgh Department of Physical Medicine & Rehabilitation and program director of the ACGME accredited Spinal Cord Injury Medicine Fellowship at UPMC. She is the director of Spinal Cord Injury Services at UPMC Rehabilitation Institute and the associate program director for the PM&R Residency Program. At the national level, Dr. Harrington serves as the co-chair of the Program Directors Council for Spinal Cord Injury Fellowships.
About Dr. Horton
Dr. Horton is board certified in physical medicine and rehabilitation and spinal cord injury medicine. He is an assistant professor at the University of Pittsburgh School of Medicine. He was the first Director of Spinal Cord Injury Services at UPMC and subsequently founded the Spinal Cord Injury Fellowship program in 2001.
