P3.J188: Don't Page Ortho: A Unified Approach to Post-Operative Pediatric Spinal Fusion Care

Purpose/Objectives: Literature has repeatedly shown the importance of having reliable, validated and consistent care plans for patients. This is perhaps most true in the acute post-operative period when variations can lead to confusion, medical error and extended hospital stays. We found this to be the case in the care of our post-operative spinal fusion patients given the varying preferences of our Orthopedic surgeons. This led to unnecessary confusion and frustration for nurses and physicians, and often resulted in frequent pages to the Orthopedic team. The goal of this quality improvement project was to create a universal order set for orthopedic surgeons to use post-operatively for their spinal fusion patients to streamline interdisciplinary communication. This would hopefully decrease the number of times providers contact each other for order clarification, and potentially decrease the length of hospital stay for the patients.

Design/Methods: The order set was created such that each surgeon can place orders that encompass the patient's entire post-operative stay. Orders are designed to add on and drop off throughout the admission according to post-operative-day. The orders include, but are not limited to a bowel regimen, ambulation, pain management, urinary catheter management, therapies, drain care, thoracic bracing, labs, imaging, antibiotic management, blood pressure parameters and transfusion guidelines.

A comparison was made between length of hospital stay for all post-operative spinal fusion patients in the year of 2022 (before the order set was implemented) and for six months after the implementation of the order set in 2024. Additionally, a survey was distributed to pediatric residents before and after the order set implementation to evaluate frequency of interdisciplinary communication for these patients.

Results: Before the implementation of the order set, 54.2% of residents stated that nursing staff contacted them for order clarification three or more times daily, and 67% of residents contacted orthopedic surgery at least two times daily. 92% of that communication was to clarify blood pressure parameters, ambulation restrictions, pain management, thoracic bracing, and drain care. After the implementation of the order set, preliminary data shows that only 13.3% of residents report nursing staff contact three or more times daily, and only 4% of residents contact orthopedic surgery at least two times daily. The preliminary data for length of stay shows a decrease by 0.20 days, bringing the average to 4.02 days.

Conclusion/Discussion: The implementation of a comprehensive order set for post-operative spinal fusion patients decreased the number of times providers contacted each other to clarify orders and decreased hospital stay length for the patients. The implications of this quality initiative can and should be translated to other post-operative conditions to continue to optimize interdisciplinary care.