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

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.

Effectiveness of a burn rehabilitation workshop addressing confidence in therapy providers.

The study first assessed comfort levels of physical and occupational therapists who provide burn care prior to a hands-on intervention, then assessed therapists' confidence levels following an educational intervention. Physical and occupational therapists who previously treated burn survivors were invited to complete a preworkshop confidence level survey. From this information, four burn rehabilitation interventional categories were identified: positioning and exercise, compression, wound healing, and burn resources. A one-day workshop was held targeting these categories. Surveys were offered at the conclusion of the workshop as well as at 6-month follow-up. Initial survey results (n = 31) indicated that more than 75% of therapists felt unconfident or strongly unconfident in providing burn rehabilitation to patients. The postworkshop survey demonstrated significant improvements in all interventional categories. Further analysis revealed that baseline confidence levels for positioning and exercise were significantly higher than the other categories (P < .03). Six-month follow-up results (n = 20) confirmed that confidence gained from the workshop remained significantly higher than preworkshop confidence levels. Baseline therapists' confidence levels in treating burn survivors were low, but improved following a one-day educational workshop. Providing hands-on burn education improved the confidence of therapists who treat burn survivors. Future efforts to improve therapist confidence and patient outcomes need to be explored.