title: Decreasing hospital length of stay following lumbar fusion utilizing multidisciplinary committee meetings involving surgeons and other caretakers.
abstract: BACKGROUND
  Although hospital length of stay (LOS) following lumbar fusion has decreased for a variety of reasons, different institutions find their LOS over the benchmarks published by the national Agency for Healthcare Research and Quality (AHRQ). Over a 3-year period, this prospective study introduced utilization of multidisciplinary committee meetings between surgeons and other caretakers to decrease LOS following spinal fusion surgery without compromising the quality of care.
  
  
  METHODS
  A multidisciplinary committee was established to assess factors and institute recommendations that influence hospital LOS following lumbar fusion compared to the national compared to the national AHRQ benchmark at baseline and at 1 and 2 years after adjusting our standard practice. We also analyzed re-admission rates at 7 and 30 days and determined the average variable direct cost.
  
  
  RESULTS
  While the national AHRQ benchmark average LOS (ALOS) was statistically better for DRGs 459 and 460 for all three years except for DRG 459 in the baseline year compared to our ALOS, we observed improvement in the ALOS for both DRG 459 and 460 throughout the 3 years of the study. ALOS for DRG 460 was statistically different for 2011-2012 vs 2013-2014 (P< 0.001) and 2012-2013 vs 2013-2014 (P< 0.001). There was a statistically significant improvement in cost initially for 2012-2013 vs 2011-2012 (P< 0.001) and for 2013-2014 vs 2011-2012 (P= 0.001).
  
  
  CONCLUSIONS
  This study established an effective patient discharge plan, patient education, partnerships with rehabilitation facilities, and study review and discussion among physicians and staff. Further monitoring of factors that impact hospital LOS following lumbar fusion is warranted to curtail patient complications and organizational expenditures while providing superior medical care.
authors.affiliation: Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA.
authors.forename: Lisa B E
authors.initials: LB
authors.lastname: Shields
authors.affiliation: Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Clark
authors.affiliation: Department of Orthopedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
authors.affiliation: Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA; Department of Anatomical Science and Neurobiology, University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Shields
keywords: Cost; fusion; hospital stay; lumbar; spine