225 Decreasing Length-of-Stay for Elective Neurosurgical Patients: Successes of a Longitudinal Quality Improvement Initiative

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INTRODUCTION: Prolonged length of stay (LOS) is associated with increased costs, higher risk of hospital-acquired complications, and suboptimal resource utilization. in neurosurgery, reducing LOS presents a unique challenge due to complex patient populations and the need for multidisciplinary care. METHODS: The authors undertook a comprehensive quality improvement initiative to decrease LOS in elective neurosurgery patients, using validated methodology to identify interventions and track results in real-time using control charts. Bi-monthly meetings with a multidisciplinary working group enabled iterative development, review and implementation of effective interventions. Outcomes were tracked prospectively over 12 months using LOS index (LOSI), defined as observed-to-expected LOS ratio. RESULTS: The initiative led to a sustained and statistically significant reduction in LOSI for elective patients, with several months surpassing the institutional target of <1. There was a significant improvement in LOSI from the pre- to post-intervention groups (1.13 vs. 0.93, p=0.039). Notable interventions include standardizing electronic medical record (EMR) order sets to include Extended Recovery After Surgery (ERAS) components, standardizing physical therapy, social work and case management processes, streamlining radiology workflows, and standardizing interdisciplinary communication. CONCLUSIONS: This initiative demonstrates that longitudinal, multidisciplinary QI efforts based on real-time analysis and data-driven adjustments can lead to impactful, sustained reductions in LOS for elective neurosurgical patients. Our initiative provides a sustainable and adaptable framework that may serve as a model for other institutions seeking to improve perioperative efficiency and patient care outcomes.

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