Right Care, Right Time, Right Place
Improving Outcomes for People with Spinal Cord Injury
Despite some progress towards curative therapies, traumatic Spinal Cord Injury (SCI) remains an irreversible condition. Clinical management after acute SCI is time-sensitive, with rapid access to specialist care being critical to achieving the best outcomes; however there are often impediments to achieving this in our current healthcare systems.
To date, no study of access to care for patients with SCI has been undertaken in Australia. The National Health and Medical Research Council has recently funded this Partnership Project to a dedicated research team, together with a number of collaborating partners across the country, under the direction of Associate Professor James Middleton at the Rehabilitation Studies Unit at the University of Sydney.
This study will collect data in NSW and Victoria, states in which there are trauma management systems and routine trauma data collections. The configuration of major trauma services and their relation to the specialised spinal cord injury units differ between NSW and Victoria, which will allow for comparison of triage protocols, transport times, bypass and inter-hospital transfer policies and processes, and patterns of care. Middleton et al. BMC Health Services Research 2014 – STUDY PROTOCOL PUBLISHED
The Access to Care project aims to detail the earliest part of the clinical journey of all patients with suspected or proven traumatic spinal cord injury, from scene of injury to definitive diagnosis and specialised treatment in a spinal cord injury unit. It will identify factors that determine clinical outcomes and well-being.
The primary hypothesis to be tested is that commencement of specialised spinal cord injury care (SSCIC) within 24 hours of injury leads to better outcomes on a range of measures, than later commencement.
Other questions include:
- Is duration > 24 hours (vs < 24 hours) from injury to commencement of SSCIC associated with worse outcomes (survival, clinical, heath status or socio-economic) up to 12 months after injury?
- What determines prolonged time to commencement of SSCIC?
- Which other factors occurring before SSCIC influence these outcomes?
- How reliable is clearance at Emergency Departments (EDs) of ambulance-assigned ‘SCI suspected’ status?
- Is assignment of ‘SCI suspected’ status unnecessary for any well-defined classes of cases to which it is presently applied?