Use of an Electronic C-Spine Clearance Strategy to Ensure Compliance With Confrontational Examinations

Abstract

The implementation of electronic medical records (EMRs) represents one of the most significant changes taking place in the medical field today. The purpose of this Performance Improvement Patient Safety initiative was to evaluate and improve the documentation of c-spine clearances by standardizing the confrontational spine examination for patients sustaining blunt trauma using the EMR. A retrospective audit of trauma charts was performed over a 6-month period to evaluate c-spine clearance documentation. Following the initial audit, a strategy, using the Donabedian Principle of problem identification, process establishment, and outcome measure, was created resulting in a template in the EMR whereby clearance of the cervical spine (confrontational examination) in nonobtunded trauma patients was standardized for all providers. Outcomes before and after implementation of the EMR protocol were compared. The initial audit revealed that 71% of records lacked appropriate documentation. Of those with documentation, 26% simply stated "c-spine cleared" or "collar removed" with no documentation to support the clinical examination performed. This is in contrast to a 95% compliance rate following the use of the EMR protocol. Up to 80% of collars were removed within 3 hours of admission thereby reducing complications associated with c-collars. The use of the EMR allowed for the standardization of the cervical spine clearance, improved documentation, and allowed for the monitoring of compliance with evidenced-based c-spine protocols. Practice implications and lessons learned in the implementation of this successful Performance Improvement Patient Safety are also described.

Quality of Reporting on Guideline, Protocol, or Algorithm Implementation in Adult Trauma Centers

“…In our appraisal of included studies, 39% (n = 29) scored ≥80% on the SQUIRE checklist 22–24,26,27,33,34,36,39–42,44,47,49,51,58,60,61,63,64,67,74–76,78,82,84,85 . Only 4% (n = 3) of all studies met all 18 SQUIRE criteria 63,76,85 .…”

“…The majority of included studies targeted physicians (51%, n = 38) 14–51 . Provider teams in dyads or multidisciplinary groups of physicians, nurses, and other health care providers were targeted in 30 studies (40.5%) 52–81 . Other studies targeted nurses (n = 2), 82,83 social workers (n = 1), 84 occupational therapists (n = 1), 85 or medical trainees (n = 2) 86,87 .…”

“…Some such studies used an explicit statement that implementation was done as a quality or performance improvement program. 57,61 Still, one-fifth of included studies did not use sufficient improvement terminology in self-labeling despite their examinations of improvements in clinical effectiveness and outcomes associated with guideline implementation. Moreover, we found many studies failed to incorporate a QI framework in their reporting, suggesting that the authors are either unaware of SQUIRE or do not view their work as a QI report.…”

“…21 The most frequent SQUIRE scores were 13 (n ¼ 9), 15,29,38,45,50,57,62,73,83 14 (n ¼ 10), 28,37,43,52,53,55,59,66,69,81 and 15 (n ¼ 12). 23,27,33,34,40,42,47,58,61,74,78,84 (Fig. 2).…”

Impact of electronic health records on predefined safety outcomes in patients admitted to hospital: a scoping review

“…An electronic protocol for the clearance of the cervical spine after mechanical trauma resulted in improved documentation. 37 A falls-prediction algorithm 47 created a notification tool for falls prevention-this was tested against a non-matched control group.…”