QI Intervention Research Articles

"Hydrate While You Wait": A QI Intervention to Apply Pre-procedural Oral Hydration in Burn Surgery.

"Hydrate While You Wait": A QI Intervention to Apply Pre-procedural Oral Hydration in Burn Surgery.

Using OR Black Box Technology to Determine Quality Improvement Outcomes for In-situ Timeout and Debrief Simulation.

The purpose of this study was to determine quality improvement outcomes following the pilot implementation of an in-situ simulation designed to enhance surgical safety checklist performance. OR Black Box (ORBB) technology allows near real-time assessment for surgical safety checklist performance. Before our study, timeout quality was 73.3%, compliance was 99.9%, and engagement was 89.7% (n=1993 cases); Debrief Quality was 76.0%, compliance was 66.9%, and engagement was 66.7% (n=1842 cases). This IRB-approved study used prospective convergent multi-methods. During 2 months, a 15-minute in-situ simulation, incorporating rapid cycle deliberate practice, was implemented for OR teams. ORBB analytics generated Timeout and Debrief scores for actual operations performed by surgeons who participated in simulation (Sim-group) versus those who did not (No-sim group) over 6 months, including 2 months pre-intervention, during-intervention, and post-intervention. Inductive content analysis was performed based on simulation discussions to determine team member perspectives. Thirty simulations with 163 interprofessional participants were conducted. ORBB data from 1570 cases were analyzed. Scores were significantly better for the Sim-group compared with the No-sim group for debrief quality (84% vs. 79% P<0.001, during-intervention), compliance (73% vs. 66%, P<0.001, post-intervention), and engagement (80% vs. 73%, P=0.012, during-intervention). There were no between-group differences for Timeout scores. Thematic analysis identified 2 primary categories: "culture of safety" and "policy." This simulation-based QI intervention created a psychologically safe training environment for OR teams. The novel use of ORBB technology facilitated outcome analysis and showed significantly better Debrief scores for simulation-trained surgeons compared with nontrained surgeons.

Quality Improvement Study Using a Machine Learning Mortality Risk Prediction Model Notification System on Advance Care Planning in High-Risk Patients

Background: Advance care planning (ACP) is an important aspect of patient care that is underutilized. Machine learning (ML) models can help identify patients appropriate for ACP. The objective was to evaluate the impact of using provider notifications based on an ML model on the rate of ACP documentation and patient outcomes. Methods: This was a pre-post QI intervention study at a tertiary academic hospital. Adult patients admitted to general medicine teams identified to be at elevated risk of mortality using an ML model were included in the study. The intervention consisted of notifying a provider by email and page for a patient identified by the ML model. Results: A total of 479 encounters were analyzed of which 282 encounters occurred post-intervention. The covariate-adjusted proportion of higher-risk patients with documented ACP rose from 6.0% at baseline to 56.5% (Risk Ratio (RR)= 9.42, 95% CI: 4.90 - 18.11). Patients with ACP were more than twice as likely to have code status reduced when ACP was documented (29.0% vs. 10.8% RR=2.69, 95% CI: 1.64 – 4.27). Additionally, patients with ACP had twice the odds of hospice referral (22.2% vs. 12.6% Odds Ratio=2.16, 95% CI: 1.16 – 4.01). However, patients with ACP documented had a longer mean LOS (9.7 vs. 7.6 days, Event time ratio = 1.29, 95% CI: 1.10 - 1.53). Conclusion: Provider notifications using an ML model can lead to an increase in completion of ACP documentation by frontline clinicians in the inpatient setting.

144 Reducing the risk of death from PJP after radical lung cancer radiotherapy – second round QI intervention updated with early outcome data

144 Reducing the risk of death from PJP after radical lung cancer radiotherapy – second round QI intervention updated with early outcome data

Implementation and impact of rapid SARS-CoV-2 point of care test on patient flow in the frailty pathway; A quality improvement approach.

To maintain patient flow during the COVID-19 pandemic, rapid and accurate decisions for the safe triage of geriatrics patients was essential as turnaround times for laboratory testing was ineffective at supporting rapid clinical decision-making for transfer of care. Thus, to mitigate and inform these clinical decisions, a quality improvement collaborative project with the geriatrics and virology department was conducted at the Frailty Assessment Unit (FAU) at Aberdeen Royal Infirmary. The goal was to facilitate patient triage during transfer of care with the introduction of Point of Care testing (POCT). The interventions which resulted in significant improvements were based on the fishbone problem solving approach and the driver diagram with change ideas informing the five Plan, Do, Study and Act (PDSA) cycles. The QI intervention was crucial in supporting clinical staff decision making during transfers for 95% of patients who had been clinically judged as asymptomatic for COVID-19 infection. High staff engagement was observed with 83% of staff suggesting the process map was easy to follow and 92% of clinical staff agreed it contained sufficient information to support the testing process. With POCT introduction, the proportion of patients who were transferred with an early POCT result increased by 20% in the Rosewell House group and by 65% in the community Hospitals group, once governance arrangements were in place. Finally, the considerable uptake of POCT by the ward consequently led to a decrease of up to 86% in the number of samples sent to the laboratory for rapid SARS-CoV-2 testing. The quality improvement project provided a rapid and reliable SARS-CoV-2 triage tool and was effectively integrated into the geriatrics triage algorithm to facilitate patient placement and flow.

689. Significant Improvement in Hand Hygiene Compliance and Decline in Clostridioides difficile Infections with Implementation of Infection Prevention Interventions

Abstract Background Per CDC, C. difficile is an urgent microbial threat. Despite use of CDC diagnostic criteria, 2-step testing protocol and antimicrobial stewardship interventions limiting broad spectrum antimicrobial use, we witnessed an increase in infections in 2022, therefore, additional interventions were implemented. Methods A multifaceted QI intervention program to improve IPC (infection prevention and control) practices was implemented in July 2022 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Interventions included: auditing and real time observations for health care personnel (HCP) hand hygiene compliance; monitoring soap/sanitizer usage; educational interventions including posters posted throughout the hospital emphasizing hand hygiene, “A clean in and clean out” approach and contact precautions reminders posted in patient rooms/nursing stations, weekly nursing huddles focused on nursing and ancillary staff education, provider counseling and continued coaching. Pre-intervention period (P1: 1/10/2021- 6/30/2022) was compared with Intervention period (P2: 07/01/2022-3/31/2023) for hand hygiene compliance and C. difficile infection rates. Results Overall adequate hand hygiene compliance rates for all health care personnel (HCP) increased from 71% during P1 to 85% during P2 (P&amp;lt; 0.05). All categories of HCP showed a significant improvement in hand hygiene compliance from P1 to P2, with rates for physicians increasing from 74% to 92% (p&amp;lt; 0.05), nurses from 68% to 94% (p&amp;lt; 0.001); nurse practitioners/physician assistants from 75% to 90% (p&amp;lt; 0.05), ancillary staff (chaplain, medical technicians, social workers) from 60% to 89% (p&amp;lt; 0.01)]. Hand hygiene product use increased significantly and soap usage alone increased from 45% to 75% in P2 (p&amp;lt; 0.05). C. difficile infections declined significantly from a mean of 1.9 infections per 1000 patient days during P1 to 0.5 infections per 1000 patient days during P2 (p&amp;lt; 0.001); SIR (Standardized infection ratio) decreased from 1.14 during P1 to 0.4 during P2 (p&amp;lt; 0.01). No C. difficile related mortality was observed. Conclusion With implementation of multifaceted IPC interventions, significantly improved hand hygiene rates and a significant decline in C. difficile infections were observed. Disclosures All Authors: No reported disclosures

Impact of quality improvement interventions on facility readiness, quality and uptake of maternal and child health services in developing regions of Ethiopia: a secondary analysis of programme data

BackgroundQuality improvement intervention (QI) was implemented from 2018 to 2021 in health facilities of developing regional states of Ethiopia. The main objective of this study was to examine the impact...

Observation of a quality improvement initiative to contextually adapt and use Robson classification in real time to collect data around CS delivery and to develop strategies to reduce CS rate

The rising trend in caesarean section (CS) rate is a global concern and, in this hospital too, it rose from 21.5% in 2010 to 32.6% in 2018. The team followed...

Transforming the transfer process: A quality improvement project to assess and improve transfer notes.

Transfer notes (TNs) standardize handoffs from one inpatient unit to another to optimize patient safety. They are especially important when patients are downgraded from high acuity settings such as intensive care units (ICU). Despite this, there is a paucity of evidence around safe transfers. The study objective was to assess the impact of a quality improvement initiative on the completion rate and quality of TNs. A retrospective chart review of TNs was conducted at a single academic center in Baltimore, MD. We analyzed 76 MICU to floor transfers pre-intervention and 73 transfers during the intervention period. Note quality was determined using a novel TN assessment tool; validity evidence was established. Chi-square analysis was used to compare the presence and quality of TNs. There was a statistically significant increase in note completion rate from 19.7% to 42.5 % during the study (p<0.003). There was a statistically significant increase in mean quality of completed TNs (10.3 pre-intervention vs. 12.3 intervention period: maximum score 15, p = 0.005). This QI intervention appears to have translated into more consistent and higher quality TNs. These improvements should facilitate better and safer care of patients moving from MICU to medical floors.

A quality improvement initiative to increase adult ECMO decision-making abilities in a perfusion education program: The use of 3D ECMO simulation.

Adult and pediatric ECMO procedures have been increasingly established as conventional life-saving modalities in critical care services across the world. Since 2017, a multidisciplinary team of program advisors for our perfusion education program have aimed to increase cardiovascular perfusion (CVP) student ECMO exposure and improve clinical decision-making. In this QI intervention, the use of 3D computer-based simulation was assessed in establishing a standardized process to improve the diagnosis and treatment of adult ECMO complications among first year CVP students. The Califia 3D Patient Simulator was incorporated into the curriculum for first year CVP students (n = 26) along with traditional lecture for the adult ECMO complication laboratory session. Pre-class knowledge assessments using de-identified polling software were compared to post-class assessments following the first assigned learning activity. Assessments from students that received simulation before lecture (SIM, n = 15) were compared to students receiving lecture before simulation (LEC, n = 11). User experience questionnaires (UEQ) consisting of 26 questions for six scales of simulation instruction were administered to measure the comprehensive impression of the student experience. Overall median [IQR] pre- and -post knowledge assessment scores were 74% [11] and 84% [11], respectively (p = 0.01). There were no significant differences in pre-class assessment scores between the SIM and LEC groups (74.0% and 74.0%, respectively, p = 0.959). The LEC group achieved higher median post-assessment scores than the SIM group (84% vs 79%, p = 0.032). Among the 26 UEQ survey scales, 23 were positively evaluated (>0.8), and three were a neutral evaluation (-0.8 to 0.8). Cronbach Alpha-Coefficients of >0.78 were measured for attractiveness, perspicuity, efficacy, and stimulation. The coefficient for dependability was 0.37. 25 (96.2%) students indicated that 3D simulation was beneficial to improving ECMO clinical decision-making. In this QI intervention, the implementation of computer-based 3D simulation following lecture was perceived by learners to help improve the diagnosis and treatment of ECMO-related complications.

Improving Wait Times for Children with Caregivers with Limited English Proficiency in the Emergency Department.

In our pediatric emergency department (ED), children triaged as low acuity who presented with Spanish-speaking caregivers with limited English proficiency (SSLEP) experienced disparately longer wait times than similarly triaged children with English-proficient caretakers. Although inequities in ED care based on language preference exist, little is known about effective interventions to eliminate the disparity. This quality improvement study aimed to eliminate the disparity in wait times and share effective interventions. A multidisciplinary team incorporating clinicians, professional interpreters, and data analysts utilized quality improvement methodology to introduce early identification of SSLEP children, standardize physician workflow, and optimize the interpreter process. The primary outcome was the length of stay. The secondary outcome was time to the provider. The balancing measures were revisits and non-LEP length of stay and time to the provider. Secondary analyses distinguished between the effect of our QI intervention and secular trends. The mean length of stay for SSLEP children decreased from a mean of 178 to 142 minutes, a 36-minute (20%) decrease. Mean time to provider for SSLEP decreased from 92.8 to 55.5 minutes, a 37-minute improvement (40%). The 72-hour-revisit rates did not increase for SSLEP children throughout the project. We identified feasible interventions to improve wait times for children with SSLEP. Future directions include addressing components of the entire ED visit to decrease the length of stay discrepancies between populations. We hope to extend our findings to benefit all LEP communities.

Impact of Updates in Headache Quality Measures on Adherence to Best Practices in a Neurology Resident Clinic (P8-12.001)

<h3>Objective:</h3> To assess the impact of a quality-improvement initiative on adherence to updated American Academy of Neurology (AAN) headache quality measures. <h3>Background:</h3> As an important resource for headache care, the AAN publishes quality measures, which were most recently updated in 2019. This single-site study at a large, academic tertiary referral center aimed to apply the AAN measures to its cohort of neurology resident physicians and evaluate adherence changes (primary outcome) as well as utilization of appropriate diagnostic criteria, patient education, and confidence in following AAN guidelines (secondary outcomes). <h3>Design/Methods:</h3> A pre-intervention (pre-QI) survey based on retrospective analysis of five clinic notes for adherence to the measures was designed and distributed to all neurology residents at our center. The intervention included creation of an electronic medical record template to aid residents in following the measures during clinical encounters as well as provision of direct feedback based on pre-QI results. Finally, a post-intervention (post-QI) survey was distributed for completion based on notes written during the intervention period. Significance testing of differences between pre- and post-QI values was performed using Chi-squared analysis. Analysis was limited to migraine headaches given a low percentage of cluster headaches seen in clinic. <h3>Results:</h3> An increase in adherence was seen in three of the four migraine-related quality measures, with two – utilization of migraine abortive therapies and counseling of modifiable lifestyle and chronification factors – showing significant improvement (p &lt; 0.01). For secondary outcomes, increases in utilization of appropriate diagnostic criteria and patient education were both significant (p &lt; 0.05), and a positive trend in self-assessed confidence rating for adherence to AAN guidelines was significant (p &lt; 0.0001). <h3>Conclusions:</h3> This study provided evidence that our QI intervention led to increased adherence to the AAN migraine-related measures. It is anticipated that increased adherence may lead to improved patient outcomes. <b>Disclosure:</b> Mr. Cascella has nothing to disclose. Dr. Anderson has nothing to disclose. Dr. Perez Martinez has nothing to disclose.

148 - Reducing the risk of death from PJP after radical lung cancer radiotherapy: second round QI intervention

148 - Reducing the risk of death from PJP after radical lung cancer radiotherapy: second round QI intervention

Increasing Identification and Follow-Up of Older Adult Depression in Primary Care.

Depression is a common mental health disorder faced by older adults that can go undetected and untreated. It was determined that the project site was not screening for depression among their older patient population. Aims: The purpose of this quality improvement project was to determine if the implementation of the Geriatric Depression Scale-15 (GDS-15) would impact the identification of risk factors for depression and follow-up among adults 65 and older. Implementation started in June 2021 in a primary care office in Southern California. Data was collected for this project over a total of 8 weeks. This project was a quality improvement project designed to implement routine depression screening among older adult patients using the GDS-15. Depressive symptoms were identified, and follow-up and treatment for depression in primary care was initiated if indicated by GDS-15 scores. Data were obtained from the project site's electronic medical record on a total sample size of 443 patients (n = 252 in the comparison group and n = 191 in the implementation group). A chi-square test indicated a clinical and statistically significant improvement in the identification rate of depression, X2 (1, N = 443) = 49.76, P < .0001; and follow-up rate X2 (1, N = 70) = 23.94, P < .0001. Clinical significance was found with an increase in the identification of depression and follow-up of older adults in primary care. Demographic variables were also compared for the QI intervention group patients according to those who scored <5 (n = 134) and patients who scored 5 or greater on the GDS-15 (n = 57) again using chi-square tests. The results showed significant differences between gender (P = .016) and primary diagnosis (P = .006). Findings of this project suggest all older adults should receive a depression screening routinely in primary care to increase the recognition of depression as well as follow-up and treatment.

Nursing Staff Involvement and Education in Sickle Cell Disease-a Single Institution Quality Improvement Initiative

Introduction: Sickle cell disease (SCD) is the most common inherited blood disorder in the US characterized by vaso-occlusive crisis leading to debilitating pain, organ dysfunction and reduced life expectancy. Despite this, health care staff receive little education on the illness and often feel uncomfortable managing it. The disease is often misunderstood and carries a perceived stigma. Our institution is faced with the additional challenge of lower staff diversity. As part of a larger quality improvement initiative at an institutional level of Sickle Cell Program development, we conducted this project to improve nursing staff level of knowledge and understanding of the disease. Aims: 1) Identify nursing staff who regularly take care of patients with SCD, evaluate their current knowledge and challenges when caring for patients with SCD, 2) Offer educational modules to address knowledge gaps and implement changes to improve comfort in caring for patients with SCD, 3) Provide a pathway that is reproducible for other institutions. Methods: The project was conducted at the University of Wisconsin Hospital by a multi-disciplinary SCD team with collaboration from the Nursing Education specialists and the Diversity Equity and Inclusion department. As a pilot cohort, we identified nursing champions who predominantly take care of patients with SCD and offered them to answer an anonymous survey. Based on their responses, educational modules on SCD were designed and video-recorded. Post-surveys were collected for feedback. The Plan-Do-Study-Act methodology was utilized to document progress and conduct tests of change. QI intervention: Educational module titled "Understanding Sickle Cell Disease and How Nursing Staff Can Help” was designed, video-recorded and uploaded on internal provider platform (U-Learn). Topics included Pathophysiology of SCD, Current treatments, Acute and chronic management of pain, Specialized nursing care for SCD and Addressing disparities, bias and stigma, specifically designed to raise awareness about the new sickle cell team, pain management plans and nursing interventions tailored to our institution. Continuing Education Units (CEU) of 1.5 hours were appointed for their completion. Following the modules, nursing champions answered a post-survey and participated in GRAPES trivia tool, known to improve knowledge and decrease negative attitudes towards patients with SCD. As next step, series of monthly Q&A meetings will be conducted with the nursing champions as an interactive platform for feedback. The nursing champion group will be expanded to form a task force that will serve as SCD patient advocates and help implement ongoing improvements. A best practice alert is being created to facilitate access to patient pain plans in the electronic chart. Patients will be offered surveys to evaluate change in satisfaction with care. Processes implemented at UW will be shared with other regional institutions. Results: Pre-intervention, 15 (65%) staff members completed the survey. The majority requested education on pain management and nursing care (Fig 1). Preliminary findings show that 20 (87%) nursing champions have signed up and 10 (43%) have completed the modules. 30% of members have completed the post-survey. The proportion of respondents reporting good/excellent disease understanding increased to 100% compared to 73% previously (Fig 2). Proportion of staff who report comfort in taking care of patients with SCD increased from 20% to 100% of the respondents (Figure 2). All respondents felt this module provided them with tools to address systematic racism faced by patients with SCD. Pre-intervention, 80% had acknowledged it's presence. Conclusion: Our preliminary data from this QI initiative shed light on deficiencies in the care delivered to an underserved patient population at our hospital, and identified areas of improvement. Lack of knowledge and misconceptions lead to low level of comfort by staff leading to sub-optimal care. Creating a nursing champions cohort interested in improving care of patients with SCD, and empowering them to be part of the change, is a feasible strategy to address institutional and systematic challenges. We started with an interactive CEU based, yet flexible educational strategy to engage staff and using their feedback, introduce ongoing improvements. Similar approach can be adopted at other institutions who face similar challenges. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

QI Intervention Can Improve Diabetes Prevention after Gestational Diabetes

According to this study: Successful diabetes prevention in women who've had gestational diabetes requires proactive building of critical improvement factors and audit feedback into routine care.

Effectiveness of a multifaceted quality improvement intervention to improve patient outcomes after total hip and knee arthroplasty: a registry nested cluster randomised controlled trial

ObjectiveTo assess the effectiveness of a prospective multifaceted quality improvement intervention on patient outcomes after total hip and knee arthroplasty (THA and TKA).DesignCluster randomised controlled trial nested in a national...

587 Ambient temperatures in the burn operating room: A QI initiative

IntroductionPatients with burn injuries are particularly susceptible to perioperative hypothermia, which is associated with a range of complications, including infection, bleeding and delayed wound healing. Raising the operating room (OR) ambient temperature is an important strategy to prevent hypothermia, but we were uncertain about how strictly we do this. The purpose of this study was to determine the ambient OR temperatures during acute burn surgery as the first step of a quality improvement initiative to ensure we are maintaining a warm OR environment.MethodsBetween 1/3/2020 and 28/2/2021, ambient temperatures during surgery in the burn OR of an ABA-verified burn center were recorded every 15 minutes. Temperatures were measured using a wall-mounted smart sensor, transmitted to a mobile smartphone application via Bluetooth. All patients undergoing acute burn excision and closure procedures lasting > 2 hours were included in the study. Hypothermia was defined as a core temperature < 36°C.ResultsOf the 119 patients, the majority were male (n=86; 72.3%), the mean age was 49.8 years (range 18-89) and the mean total body surface area (TBSA) was 15.8% (range 1-62%). They underwent 261 operations (mean 2.2 cases per patient; range 1-15) with a mean duration of 211.1 minutes (range 120-468 minutes). Sixty-two patients underwent 1 surgery, and 31 had 2 surgeries. Eight patients (6.7%) died. Thirty-three patients (27.7%) were hypothermic at the end of 43 cases (16.5%).The mean ambient temperature was 24.8oC (range 18.7oC to 29.6oC). Hypothermic patients (n= 33 patients, 43 cases), did not differ significantly in age or operative duration from non- hypothermic patients (n= 86 patients, 218 cases) but did have significantly larger %TBSA burns [32.3 vs 24.8 (p= 0.02)]. Hypothermic cases experienced significantly lower ambient temperatures at the start of surgery (p=0.007), and mean temperature during surgery (p=0.009), and tended to experience a lower ambient temperature at the end of surgery (24.5 C vs 25.1 °C , p= 0.06). [Table]ConclusionsWe have identified that the ambient temperature in our burn OR is lower than desirable and that this is directly related to development of hypothermia. These results now indicate that a QI intervention (stricter attention and manoeuvers to ensuring a warm operating room at the start and during surgery) is required.

Abstract 10298: Improving the Ability to Assess and Detect Delirium in Postoperative Cardiac Surgery Patients

Introduction: Delirium is common in cardiac intensive care units due to illness related stress, polypharmacy, interventions, excessive light and noise, disorientation and sleep disruption. Delirium assessment is poor due to limited nursing knowledge and the lack of integrated features in electronic health platforms (EHR) to support accurate assessment and documentation. Hypothesis: We hypothesized that education on use of the Confusion Assessment Method for the ICU (CAM-ICU) and enhanced features in the EHR would improve the ability to detect delirium in our CTICU. Methods: We conducted a QI intervention using a PDSA approach and pre-post evaluation design. In the Planning phase audited 100 randomly selected charts to determine baseline documentation of delirium. We conducted a survey of nurses’ knowledge of delirium and documentation criteria and identified a knowledge deficit. In the Do phase, a multi-stage educational initiative was used to address delirium awareness, knowledge, and CAM-ICU documentation competency. Enhancements in the EHR were made to enable accurate assessment, documentation and scoring using embedded logic. Post-intervention audits (n=100) were performed. Results: Survey respondents (n=64) averaged 31 years old (SD 1.4) and had 6 years nursing experience on average (median=3, range &lt;1-40). Nurses believed patients with delirium had longer ICU LOS and worse outcomes and patients would benefit from screening. Most lacked training in delirium screening (88.1%, n=58). Baseline documentation of at least one assessment of delirium was 44% (n=44) and post-intervention was 100% (p&lt;0.001). Accuracy of CAM-ICU assessments at baseline was challenging to determine due to a single field (YES/NO/UTA) in the EHR, however, positivity of pre-intervention assessments was 1% (n=1) and post- intervention at least 1 positive CAM score was recorded in 33% (n=33) of patients (p&lt;0.001). Conclusions: Findings suggest that a multi-stage educational intervention paired with EHR integrated scoring logic improves awareness, knowledge and documentation accuracy for delirium in the ICU, which may improve patient safety and ICU outcomes. Better assessment and documentation may improve patient safety and ICU outcomes.

P.225 Factors Contributing to Prolonged Length of Stay in Adults Undergoing Spine Surgery: Results from a Quaternary Spinal Care Center

Background: Prolonged length of stay (LOS) is associated with increased resource utilization and worse outcomes. The goal of this study is identifying patient, surgical and systemic factors associated with prolonged LOS overall and per diagnostic category for adults admitted to a quaternary spinal care center. Methods: We performed a retrospective analysis on 13,493 admissions from 2006 to 2019. Factors analyzed included patient age, sex, emergency vs elective admission, diagnostic category (degenerative, deformity, oncology, trauma), presence of neurological deficits in trauma patients, ASIA score, operative management and duration, blood loss, and adverse events (AEs). Univariate and multivariate analyses determined factors associated with prolonged LOS. Results: Overall mean LOS (±SD) was 15.80 (±34.03) days. Through multivariate analyses, predictors of prolonged LOS were advanced age (p&lt;0.001), emergency admission (p&lt;0.001), advanced ASIA score (p&lt;0.001), operative management (p=0.043), and presence of AEs (p&lt;0.001), including SSI (p=0.001), other infections (systemic and UTI) (p&lt;0.001), delirium (p=0.006), and pneumonia (p&lt;0.001). The effects of age, emergency admission, and AEs on LOS differed by diagnostic category. Conclusions: Understanding patient and disease factors that affect LOS provides opportunities for QI intervention and allows for an informed preoperative discussion with patients. Future interventions can be targeted to maximize patient outcomes, optimize care quality, and decrease costs.