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J Neurotrauma. 2017 Oct 15;34(20):2910-2916. doi: 10.1089/neu.2016.4935. Epub 2017 Mar 29.

Understanding Length of Stay after Spinal Cord Injury: Insights and Limitations from the Access to Care and Timing Project.

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1 Division of Physiatry, Department of Medicine, University of Toronto , Toronto Ontario, Canada .
2 Rick Hansen Institute , Vancouver, British Columbia, Canada .
3 Operations and Logistics Division, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada .
4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada .
5 Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada .
6 University of Toronto Spine Program , Toronto, Ontario, Canada .
7 Université Laval , Québec, Canada .


Costs associated with initial hospitalization following spinal cord injury (SCI) are substantial, and a major driver of costs is the length of stay (LOS); that is, the time that the injured individual remains hospitalized prior to community reintegration. Our aim was to study the factors and variables that contribute to LOS following traumatic SCI. Modeling (process mapping of the SCI healthcare delivery system in Canada and discrete event simulation) and regression analysis using a national registry of individuals with acute traumatic SCI in Canada, existing databases, and peer-reviewed literature were used to examine the driver of LOS following traumatic SCI. In different jurisdictions, there is considerable variation in the definitions and methods used to determine LOS following SCI. System LOS can be subdivided into subcomponents, and progression through these is not unidirectional. Modeling reveals that healthcare organization and processes are important contributors to differences in LOS independent of patient demographics and injury characteristics. Future research is required to identify and improve understanding of contributors to LOS following traumatic SCI. This will help enhance system performance. Work in this area will be facilitated by the adoption of common terminology and definitions, as well as by the use of simulations and modeling.


LOS; SCI; delivery of healthcare; health services research

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