Inpatient rehabilitation wheelchair management quality improvement project: Implications for patients with spinal cord injury

Abstract

Context/Objective: Evaluate hospital fleet wheelchair (WC) requests submitted by physical therapists (PT) for patients with spinal cord injury (SCI) to trial and use during inpatient rehabilitation. Design: Quality improvement project secondary analysis of delivery process and WC trials. Setting: Urban inpatient rehabilitation hospital. Participants: Internal review of 4,371 WC requests narrowed to 750 patients with SCI. Interventions: PTs submitted WC requests between March 25, 2017, and September 30, 2019. Outcome Measures: WC delivery timeframe, level of SCI, type of WC. Results: PTs requested power (28%), and manual WC bases: standard (19.1%), tilt (18.9%), ultralight rigid (18.9%), ultralight folding (13.5%), and recliner (1.6%) respectively. Patients received fleet WCs 49.9% of the time within specified urgency timeframes. A Chi-Square test showed a significant association between WC request urgency and fulfillment within established timeframes (χ 2 = 19.68, P < 0.001, n = 750). Broken down by urgency level: 60.0% low (n = 12), 56.2% medium (n = 244), and 39.9% high (n = 118) received their WC within established timeframes. Patients with cervical level SCI (n = 162) had the highest mean wait time of 8.28 days for power WCs. The second highest wait time was 6.29 days (SD 6.6) for manual ultralight rigid WCs (n = 34). Conclusion: Inpatient fleet WC delivery is critical to patients with SCI. Variation occurs by WC type requested and by the level of injury. Gaps exist in providing appropriate WCs in facility timeframe guidelines by the level of urgency that is within 24 h for high, 3–5 days for medium, and 5–7 days for low.