Acute Traumatic Spinal Cord Injury: Implementation of a Multidisciplinary Care Pathway

Abstract

QUALITY IMPROVEMENT BACKGROUNDAcute traumatic spinal cord injury (SCI) is a devastating and chronically debilitating injury associated with neurologic impairment, as well as with systemic complications involving the pulmonary, gastrointestinal, genitourinary, and integumentary systems, among others (Sweis & Biller, 2017). More than two in three patients, for example, experience severe respiratory complications, 27%-62% experience impairments in bowel function, and 3.0%-19.2% experience neurogenic shock (Hagen, 2015). Mortality is common, and rates of acute inpatient mortality have increased in the United States 7.5% in 2012 (Jain et al., 2015). Although it is a relatively rare disease-with an incidence of 40 new cases per 1 million people-such adverse patient outcomes negatively affect overall health care burden (Devivo, 2012). For example, cost for SCI treatment is estimated to be over $9 billion annually with approximate direct medical costs exceeding $21,000 per patient (French et al., 2007). These numbers persist greater than 2 years from injury and are hypothesized to be due in part to complication recognition and management.At our Level I trauma center, a revision and update of the existing acute traumatic SCI pathway was planned for 2020. The last planned revision was in 2010. However, the occurrence of several unanticipated adverse events over a 1-month period-including two readmissions to the intensive care unit (ICU), one intubation, and one death-highlighted the need for more immediate review and evaluation of the existing acute traumatic SCI pathway to identify opportunities for improvement.

A Predictive Model of Failure to Rescue After Thoracolumbar Fusion

“…25 Although escalating care after certain complications has reduced mortality, the association between FTR and type of complication challenges its role as a quality metric. 26 Our results support the need for a similar risk-adjusted metric with respect to frailty in patients undergoing TLF. 24 Previous literature has identified patient predictors of FTR in spine surgery.…”

“…The wide variance in FTR rates necessitates that the primary care teams implement individualized protocols according to each complication type [ 25 ]. Although escalating care after certain complications has reduced mortality, the association between FTR and type of complication challenges its role as a quality metric [ 26 ]. Our results support the need for a similar risk-adjusted metric with respect to frailty in patients undergoing TLF [ 24 ].…”