Resident Physician Brown University Providence, Rhode Island, United States
Disclosure(s):
Rohaid Ali, MD: No financial relationships to disclose
Introduction: The length of stay index (LOS-I), which is the ratio of the observed to the expected length of stay, is a commonly used benchmark when evaluating the quality of a hospital or service line, and there is increasing emphasis on optimizing this quality metric within spine surgery. To date, little work has focused on how charting style affects the LOS-I in spine surgery.
Methods: We performed a comparative interrupted time-series analysis at an urban, academic, level I trauma center. The intervention consisted of adjusting the charting style from system-based to problem-based charting on an inpatient, neurosurgery spine surgery service line. Data on expected LOS, observed LOS, and the LOS-I was gathered from Vizient for the 12 months prior to intervention and the 20 months following intervention.
Results: In the intervention cohort, there was a significant increase in the expected LOS (p=0.0189) over the course of the study period. The observed LOS remained unchanged (p=0.9934), while there was a significant decrease in the LOS-I (p=0.0257). In a comparison group of patients receiving spine surgery by orthopedics, whose providers were not exposed to the documentation intervention, there was no statistical change in the LOS-I over the course of the study period.
Conclusion : On an inpatient, neurosurgery spine surgery service line, changing from system-based to problem-based charting was associated with a statistically significant decrease in the LOS-I, a key measure of healthcare quality. The study illustrates the degree to which charting style can influence risk-adjusted quality metrics on a spinal surgery service line.
