Time to clearance from spinal precautions in patient with spinal fractures: a review into factors contributing to delays.
Hayley Deacon1 1Ramsay Health Care – Joondalup Heath Campus, Perth, Western Australia, Australia
Abstract
The management of patients post spinal trauma is complex and requires specialised, multidisciplinary care that is coordinated to minimise delays and the time patients are immobilised on ‘spinal precautions’ (SP). Prolonged use of SP (>72 hours) has been linked to increased hospital length of stay (LOS), hospital-acquired complication rates and healthcare costs. The aim of this audit was to identify factors contributing to delays in SP clearance and to determine the effects of these delays on patient and hospital outcomes at Joondalup Health Campus (JHC), a busy urban hospital without a state major trauma service.
A clinical audit was conducted retrospectively for patients admitted to JHC with acute spinal fracture/s during 2020. After exclusion criteria, 81 patients were included in the audit. Most patients (89%) were managed conservatively, with or without spinal bracing and 11% required surgery. The average length of time patients spent on SP was 2.06 days and 26% of patients remained on SP for prolonged periods (≥72 hours). Patients on prolonged SP had higher hospital-acquired complication rates and averaged an 8 day longer LOS compared to patients cleared within 48 hours, resulting in an estimated additional annual cost to JHC of $457,296. Factors contributing to delays included time to orthotist review, magnetic resonance imaging (MRI) scans and review of radiological imaging. Recommendations to facilitate safe and timely SP clearance included the implementation of a multidisciplinary hospital-wide spinal injury guideline, reviewing MRI accessibility and upskilling experienced physiotherapists in spinal bracing to eliminate wait times for external orthotists.
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