PATHWAYS IN SPINAL CORD INJURY

Transcription

1 Siracusa Ottobre 2013 PATHWAYS IN SPINAL CORD INJURY 1 M. G. Onesta, M.D. Director of Spinal Unit Cannizzaro Hospital Catania T. Di Gregorio, MD, PhD, Physiatrist of Spinal Unit Cannizzaro Hospital Catania

2 ABOUT RULE IN ITALY The change in the care and rehabilitation of people with spinal cord injury occurs with the publication of the "Official Gazette n. 124, in date of the Guidelines of the Minister of Health for rehabilitation activities, where for the first time was specified that people with spinal cord injury had to be cared for in specific specialized unit in the hospitals, located at emergency department, called Unipolar Spinal Unit (USU). Guidelines of the Minister of Health for rehabilitation activities " (Published in the Official Gazette of 30 May 1998, n. 124) 2

3 SPINAL UNIT DEFINITION The Unipolar Spinal Unit (USU)is a multidisciplinary professional organization specialized for the needs (therapeutic, rehabilitative and psychological-social) of people with spinal cord injury. 3 Basaglia N. Proposed guidelines for the organization of Rehabilitation Medicine. Working Group ministeriale.giorn.ital. Med Physics and Riabilit

4 WHEN??? The care pathway starts from the earliest stages of the spinal cord injury through prevention of immediate complications, until you reach the full recovery of the residual functions and the highest possible level of autonomy in the later stages. 4

5 HOW? The activities that take place within the USU affect all aspects of disability resulting from the spinal cord injury: Respiratory neuro-motor bladder-sphincter psychological and sexual function 5 Rehabilitation in spinal cord injury. Bonavita. Masson 2004

6 EPIDEMIOLOGY SCI 78.2% males (mean age 37.6 years) SCI > 60 ages 10% Incomplete quadriplegic 34.5% Complete paraplegic 23.1 % Complete quadriplegic 18.4 % Incomplete paraplegic 17.5% 90% with life expectancy comparable to the reference population Lichici,

7 «A SERIES SERIES OF SYSTEMIC REVIEWS ONTHE TREATMENT OF ACUTE SPINAL CORD INJURY NJURY: A FOUNDATION FOR BEST MEDICAL PRACTICE» Michael G Fehinings et Al. Journal of neurotrauma 28, 2011 Specialized centers of care for SCI 7

8 HUB & SPOKE The "Hub & Spoke model is a system of connections arranged like a chariot wheel, in which all traffic moves along spokes connected to the hub at the center. This theory expresses a dynamic idea (before structural ) of the assistance, connected to the degrees of complexity center that provides for a system of integrated services that include high specialty and emergency. 8

9 HUB & SPOKE The Hub & Spoke model involves the concentration of care with higher complexity in "reference centers highly specialized" (Hub). Patients that exceed the threshold of the complexity of the interventions possible at the peripheral level (Spoke) are sent to the Hub centers. 9

10 HUB & SPOKE For each of the reference centers is neccessary to identify the geographical area: the reference population, care pathways, functional characteristics, structure and organization of the network nodes, the reference criteria among the services, the criteria threshold for transfering patients to more specialized centre. 10

11 HUB & SPOKE Hub (Spinal Unit) Spoke A (Spoke for Acute patients) are divided into; Spoke AT (Acute Spoke Traumatic SCI) Spoke A (Acute Spoke Non traumatic SCI) Spoke O (Spoke Ospedalieri - hospitals) Spoke T (Spoke Territoriali local services) 11

12 Spinal Units N beds USU Torino - Az. Osp. Cto/M. Adelaide 54 US Novara- Osp Maggiore della Carità 10 US Alessandria- Osp Borsalino 16 USU Pietra Ligure - A.O. Santa Corona 25 USU Milano - A.O. Ospedale Niguarda Ca'Granda 36 US Ospedale CTO Milano 21 US Sondalo - A.O. Della Vatellina e Valchiavenna 20 US Mozzo (BG) 12 US Integrata (RHO Passirana) 16 US Vicenza - Ospedale Civile - ULSS 6 di Vicenza 20 US Udine- Osp. Gervasutta 28 US Negrar - Ospedale Sacro Cuore 15 USU Firenze - A.O. Careggi 50 USU Perugia. A.O. Ospedale Silvestrini 10 USU Roma - C.T.O. "A. Alesini" 16 US Centro Paraplegici di Ostia 23 USU Cagliari - Ospedale Marino 15 US Montecatone Rehabilitation Institute 128 US Villanova D arda (PC) US Ferrara- Osp Sant Anna?? US Sulmona Abruzzo 25 US Cassano Murge - Puglia 14 USU CATANIA 20 Fondazione ISTUD INAIL Spinal Unit in Italy n tot. beds

13 The early transfer of SCI to a specialized center of care will be organized early to contain the total length of hospitalization. The early transfer to a specialized multidisciplinary center SCI can reduce the mortality of patients and the number of complications. Parent et al

14 .PATH TO U.S.U. Valutation and treatment from the staff of Spinal Unit CRITICAL AREA Contact the staff of the spinal unit USU Other hospitals 14

15 CARE PATHWAY The transfer to USU starts with the emergency phase and it extends until the socio-familiar recovery... It aims to obtain the recovery of maximum autonomy and independence of the patient with SCI With the active involvement and coordination of the USU and rehabilitation in territorial structures. EMERGENCY PHASE ACUTE PHASE STABILIZATION PHASE PHASE of POST-DISCHARGE or RETURNS 15

16 The Physiatrist: role The physiatrist takes care about the patient as soon as possible (within 24 hours) after acceptance, extends the clinical level and is responsible for the single path on an individual patient 16

17 the TEAM visit is an important moment to exchange and compare ideas between the professions involved in the care pathway. The daily briefings encourage better communication and better climate between operators, limiting the necessity of the simultaneous presence of more professionals in selected cases, develop integrated medical record 17

18 Organization in unipolar spinal unit HOSPITALIZATION Starts with defining the early interventions and objectives During the First Day The TEAM evaluates the case after1 week And every month The TEAM meeting takes place and FAMILY is informed about the program REHABILITATION PROJECT 18

19 CONCLUSIONS A correct rehabilitation care, based on a project and program shared by the multidisciplinary team, may facilitate management of the patient from the acute phase to return to the home To remember that is essential to start the transfer of a person with spinal cord injury as fast as possible... 19