Reducing process barriers in acute hospital for spinal cord damage patients needing spinal rehabilitation unit admission

Study design:Prospective open cohort case series.Objectives:To identify opportunities for improvement by recording duration of key processes from acute hospital admission until spinal rehabilitation unit ( SRU) admission.Setting: SRU, Victoria, Australia.Methods:Consecutive referrals of patients with recent spinal cord damage had prospective documentation of the key clinical and demographic characteristics and duration ( days) of the following sequential discrete processes: acute hospital admission until referral to SRU, referral until SRU assessment, SRU assessment until ready for transfer to SRU and ready for transfer until SRU admission.Results:A total of 347 patients were referred with median age ( interquartile range ( IQR)) of 65 ( 52-76) years. Most patients were male ( n=203, 58.5 ), had paraplegia ( n=267, 77 ) and an aetiology due to spinal cord myelopathy ( n=280, 80.7 ). There was a median of 12 days ( IQR 6-20) from acute hospital admission until referral, a median of 1 day ( IQR 0-2) from referral till assessment, a median of 0 ( IQR 0-3.5) days from assessment till deemed ready and a median of 7 ( IQR 2-20) days from deemed ready until transfer to SRU. Overall, patients spent 34.2 ( 4951/14 478 days) of their acute hospital length of stay waiting for a SRU bed.Conclusions:There are opportunities to improve the efficiency of the acute hospital journey for patients referred to a SRU. The biggest opportunities exist for reducing the time from acute hospital admission till referral to SRU and the time from deemed ready for transfer to SRU till admission.