Impact of an order set on communication and length of stay after pediatric spinal fusion

Abstract

Background: This study aimed to evaluate the impact of a standardized postoperative order set on interdisciplinary communication and hospital length of stay (LOS) among pediatric patients undergoing posterior spinal fusion (PSF) for idiopathic scoliosis.

Methodology: LOS was compared among patients younger than 18 years using Epic SlicerDicer data from the pre-implementation period (2021 through January 17, 2024; n = 58) and the post-implementation period (January 18 through December 2024; n = 14). Pediatric residents were surveyed regarding the frequency of interdisciplinary communication before and after implementation. Statistical analyses used Fisher’s exact test and an independent-samples t-test.

Results: Mean LOS decreased from 3.91 days pre-implementation to 3.71 days post-implementation, though not statistically significant (p = 0.60). Survey responses demonstrated significant reductions in paging frequency for pain management (p = 0.043), drain output (p = 0.004), and pediatric-to-orthopedic communication regarding blood pressure concerns (p = 0.010). Overall interdisciplinary communication between pediatrics, orthopedics, and nursing improved.

Conclusions: Implementation of a standardized postoperative order set for pediatric patients undergoing PSF for idiopathic scoliosis significantly reduced unnecessary paging related to pain management, blood pressure monitoring, and drain output, while enhancing interdisciplinary communication. A trend toward shorter LOS was observed. These findings align with prior evidence that structured, diagnosis-specific order sets improve care coordination, efficiency, and patient outcomes in pediatric inpatient settings.

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