Implementing an Interdisciplinary Order Set for Amputation

PURPOSE: This quality improvement study evaluated a novel, electronic medical record (EMR)-based order set designed to standardize interdisciplinary care coordination for patients undergoing lower extremity amputation at a large academic medical center. When activated, the order set automatically placed consultations for an interdisciplinary team consisting of physical therapy, occupational therapy, physical medicine and rehabilitation (PM&R), chaplaincy, and orthotics/prosthetics. METHODS: Patients (n=637) who underwent lower extremity amputation were divided into 2 cohorts: those with and without use of the amputation order set. Interdisciplinary consultation patterns, length of stay (LOS), and discharge disposition were analyzed. RESULTS: The order set significantly increased consultations with PM&R, chaplaincy, and orthotics/prosthetics services. While overall hospital LOS was longer in the order set group, patients who received preoperative order set placement had significantly shorter time from surgery to discharge. In addition, patients in the order set group were more likely to be discharged to inpatient rehabilitation facilities, as opposed to skilled nursing facilities or directly home. CONCLUSIONS: Findings suggest that structured interdisciplinary coordination, particularly when initiated preoperatively, can enhance discharge planning and facilitate higher-quality rehabilitation pathways. The implementation of a standardized amputation consultation panel within the EMR supports provider adoption and may reduce disparities in care access.