Impact of the physical therapy–managed spinal orthoses program on cost of care in the hospital setting: a retrospective interrupted time-series study

Abstract

Abstract Background The physical therapy (PT) department at a level 1 trauma center identified vendor delivery delays of off-the-shelf (OTS) spinal orthoses that delayed patient mobilization. Objective This study aimed to identify improvements in mobilization times, discharge times and reduction in the cost of care after centralizing the management of orthoses within the therapy department. Method The centralized management of OTS spinal orthoses included stocking three adjustable lumbosacral and thoraco-lumbosacral orthosis sizes and ensuring that all personnel received training to appropriately fit the orthoses to patients. This study evaluates the impact of the centralized program by using a retrospective interrupted time-series design to compare outcomes before and after program implementation. Outcome measurements included orthosis delivery delay, time to orthosis delivery, time to mobilization by physical therapist, length of stay (LOS) and cost of care. Segmented linear regression, Wilcoxon rank-sum test and Fisher's exact tests compared outcome measures before and after implementing the centralized program. Results The PT-managed program eliminated orthosis delivery delays noted during the vendor program (42 vs. 0; P < 0.001), resulting in an overall 13.97-h reduction in time to mobilization (P < 0.001). Program cost savings equated to $2,023.40 per patient (P < 0.001). Sub-group analysis of patients without complications and treated conservatively showed a significant reduction in LOS (15.36 h; P = 0.009) in addition to time to mobilization reductions. Conclusion The PT-managed program significantly improved the quality of care for patients who required a spinal orthosis by mobilizing patients as soon as possible, allowing timely discharge. The program also resulted in overall patient and hospital cost savings.