Correlations Between Wheelchair Provision Time for Hospital Inpatients and Their Lengths of Stay and Costs of Hospitalization

The wheelchair provision process within the Central Zone of Nova Scotia Health includes the ordering, assembly, and delivery of wheelchairs from where the inventory is stored at the Nova Scotia Rehabilitation and Arthritis Centre to inpatient units at 10 sites. At discharge from hospital, the wheelchair is typically returned, cleaned and placed back in inventory. The WheelEase software that tracks components of this process was developed locally in 2001, ownership of which has transferred to the Nova Scotia Health Assistive Technology Program. The software has been periodically refined. As an indication of the volume or orders, during the 6-month period from April 1 to September 30, 2021, there were 257-277 orders per month (~13/weekday) and the WheelEase database includes over 34,000 historical wheelchair orders. People who require wheelchairs after discharge need to rent or purchase them, a process that can take several months.

During the 2022-2023 Academic Year, the Wheelchair Research Team proposed and directed a Pilot Study by a group of four final-year Industrial Engineering students. The objective of the Capstone Project was to analyze Nova Scotia Health's wheelchair provision process for inpatients in the Central Zone and provide recommendations that might improve the quality of care provided and save costs. The students used a variety of methods to collect data including regularly checking loading docks and delivery spaces, tracker sheets, Global Positioning System trackers, interviews, contextual inquiry and shadowing of wheelchair technicians, a survey of Occupational Therapists (of whom there were 64 in the Central Zone), a discrete-event simulation to compare sequencing rules for the order in which the technicians build wheelchairs and a review of the existing WheelEase database.

Among other findings from the Pilot Study, during an 11-weekday period in late January 2023, the median Wheelchair Lead Time of 119 wheelchairs was 2.98 days, with median Wheelchair Assembly Time and Wheelchair Delivery Time components of 0.98 and 1.00 days respectively. Variations among sites and the day of the week that the order was placed were identified. The average 24-hour cost of a hospital bed in the Central Zone was $1,101 (range $557-1,313).

By comparison, in a quality-improvement project on 750 inpatients with spinal cord injury in a large American hospital, Taylor et al. reported that patients with cervical-level injury had the highest mean wait times (8.28 days) for powered wheelchairs and the second highest was for manual rigid-frame wheelchairs (6.29 days). Other studies have found that the early mobilization of patients can lead to reductions in medical complications, lengths of stay and costs.

In summary, reductions in the Wheelchair Lead Time could speed patient mobilization (with benefits to the patient) and reduce the patient's hospital Length of Stay and the patient-related Cost of Hospitalization. However, at this time, these potential benefits remain speculative. The objectives for this Project are to test the hypotheses that there are positive correlations between Wheelchair Lead Time and both Length of Stay and the Cost of Hospitalization.