St andards for Pat ie nt s Re quiring Spinal Cord Injury Care

Transcription

1 May KENT, SURREY & SUSSEX LOCAL SPECIALIST COMMISSIONING GROUP Re vie w of Spinal Cord In jurie s Se rvic e s for He alt h Aut h oritie s in South We s t, South Eas t, Lon don an d Eas t e rn Re gion s St andards for Pat ie nt s Re quiring Spinal Cord Injury Care J oint St andard De ve lopm e nt Groups of t he South of England Re vie w Gro up

2 Th e a im s of th e Region a l Sta n d a rds a re to:- ƒ Provide gu id a n ce on sta n da rds of ca re a n d s ervice delivery to th ree s pecia lis t cen tres wh ich p rovide s pin a l cord in ju ry s ervices ƒ Prom ote con s is ten cy between cen tres ƒ En a b le com m is s ion ers of ca re to a ss ess ach ievem en t of s pecified Sta n d a rds Th e s ta n da rds h a ve been divided in to 16 top ics wh ich s pa n th e pa tien t pa th wa y a n d orga n is a tion of th e s pin a l cord in ju ry s ervice. Ea ch s ta n d a rd com pris es a s et of explicit criteria wh ich n eed to be fu lfilled in order to a ch ieve th e s ta n da rds. Ea ch criterion h a s a des ign a ted tim e s ca le a n d m eth od for dem on s tra tion of a dh eren ce. Ita lic p rin t in d ica tes th a t th e criteria a re repea ted in oth er topic s ection s Ke y t o Crit e ria Le ve ls : 1 = essen tia l 2 = to be m et with in twelve m on th s 3 = to be m et with in th ree yea rs 4 = to be m et with in five yea rs Le ve l 1 in d ica tes th e h igh es t priority th a t s pin a l cord in ju ry cen tres s h ou ld give to com plia n ce a n d to em ph a s is e th e im m ed ia te direction for s ervice im provem en t. Le ve ls 2, 3 & 4 h a ve been s et to a llow tim e for im p rovem en t. St an dards Top ic 1 Pa tien t Cen tred Ca re Top ic 2 Orga n is a tion of Sp in a l Cord In ju ry Ca re Top ic 3 Com m u n ica tion between prim a ry, s econ da ry a n d tertia ry s ervices Top ic 4 Ma n a gem en t a n d orga n is a tion of Sp in a l Cord In ju ry Ca re service Top ic 5 Acces s, as s es s m en t a n d d ia gn os is Top ic 6 Acu te Ca re Top ic 7 Sp in a l s u rgery & follow-u p Top ic 8 Reh a b ilita tion Top ic 9 Rein tegra tion Top ic 10 Review Top ic 11 Re-a dm is s ion Top ic 12 Pa ed ia tric Sp in a l Cord In ju ry s ervices Top ic 13 Edu ca tion a n d tra in in g Top ic 14 Res ea rch a n d developm en t Top ic 15 In form a tion Ma n a gem en t & Au d it Top ic 16 Ma n a gem en t of pa tien ts with SCI & oth er s ign ifica n t in ju ries May

3 Topic s of St an dards 1.0 Pat ie nt Ce nt re d Care 1.1 Th e s pin a l cord in ju ry s ervice will be des ign ed a n d developed a rou n d th e n eeds of th e pa tien t a s a n in d ivid u a l 1.2 Ea ch pa tien t s perception s, expecta tion s, a n d n eeds will be con s idered to m a xim is e th e ben efit from s pin a l cord in ju ry s ervice ca re. 1.3 Pa tien ts will be ca red for in a n a pp rop ria te en viron m en t a n d accou n t ta k en of th eir s pecia l n eeds, wh ich will va ry accordin g to th eir clin ica l con d ition 1.4 Th e pa tien t will be p rovided with in form a tion in order to a ctively pa rticip a te in th eir h ea lth ca re progra m m e 1.5 Pa tien ts requ irin g u rgen t ca re or pla ced on a wa itin g lis t will receive a ss ess m en t/ trea tm en t a t th e optim u m tim e for th eir ca re 1.6 Th e pa tien t s ca re will be provided a s close to th eir h om e a s is pra ctica b le a n d a pp rop ria te 2.0 Organis at io n of Spinal Cord Injury Care 2.1 Th e n eeds of th e s pin a l cord in ju red popu la tion will be m et by a dequ a tely res ou rced Sp in a l Cord In ju ry Cen tres 2.2 A s pecia lis t tea m will be con s ta n tly a va ila b le to m eet th e n eeds of th e popu la tion s erved 2.3 Adequ a te a dm in is tra tive s u pport will be a va ila b le to s ervice both th e n eeds of pa tien ts a n d clin ica l in form a tion 2.4 Wh ere ca re of pa tien ts is n ot provided with in th e SCIC, co-ordin a tion will exis t between u n its for th eir effective m a n a gem en t 3.0 Com m unic at io n be t we e n Prim ary, Se c o ndary and Te rt iary Se rvic e s 3.1 Th ere will be effective com m u n ica tion between a ll levels of ca re a n d a ll s p ecia lities a n d p rofess ion a l grou ps 3.2 Th ere will be a wa ren es s of s ervices provided by th e Sp in a l Cord In ju ry Cen tres 3.3 Th ere will be effective pla n n in g a n d com m u n ica tion a bou t th e s ervices requ ired by a n in d ivid u a l p a tien t 3.4 Th e u s e of in form a tion tech n ology, in clu d in g electron ic im a ge tra n s fer will be m a xim is ed a s a s u pp ort to con s u lta tion, com m u n ica tion a n d decis ion m a k in g 4.0 Man age m e nt of Spinal Cord Injury Se rvic e 4.1 Sp in a l Cord In ju ry s ervices will h a ve a n effective m a n a gem en t s tru ctu re with clea r lin es of a ccou n ta b ility a n d res pon s ibility 5.0 Ac c e s s, Ass e ss m e nt and Diagnos is 5.1 All fron t lin e s ta ff in p rim a ry a n d s econ da ry ca re will u n ders ta n d th e n eed for a n d prin cip les of app rop ria te m a n a gem en t of th e pa tien t a n d receive a dequ a te tra in in g in on wa rd referra l. 5.2 Sp in a l Cord In ju ry Cen tres will h a ve a n d d is s em in a te criteria for con s u lta tion a n d for a d m is s ion. 5.3 Ad m is s ion or tra n s fer to th e Sp in a l Cord In ju ry Cen tre for trea tm en t of a n a cu te s pin a l cord in ju ry will be com pleted with in th e a greed tim es ca le a n d a ll oth er a dm is s ion s in a ccord a n ce with Na tion a l Sta n da rds 5.4 Cu rren t in form a tion a bou t ou t-pa tien t wa its a n d bed-s ta te will be rea d ily a va ila ble to referrin g clin icia n s a n d receivin g clin icia n s. 6.0 Ac ute Care 6.1 Mu lti-p rofes s ion a l tea m s will work togeth er, a cros s dis cip lin es a n d loca tion s to a ch ieve optim u m decis ion m a k in g, trea tm en t a n d ou tcom e 6.2 Ma n a gem en t a t th e a cciden t s cen e & du rin g tra n s fer to h os pita l will be provided in a ccorda n ce with n a tion a l & SCIC gu idelin es 6.3 Ma n a gem en t in th e a cciden t & em ergen cy depa rtm en t will be provided in a ccorda n ce with n a tion a l & SCIC gu idelin es 6.4 All fron tlin e s ta ff will u n ders ta n d th e n eed for a n d p rin cip les of a pprop ria te pa tien t m a n a gem en t a n d receive a dequ a te tra in in g in on wa rd referra l 6.5 Clin ica l pa t h wa ys a n d tim e s ca les will be esta blis h ed in rela tion to s everity of in ju ry May

4 6.6 All pa tien ts will h a ve a pprop ria te & tim ely a cces s to th e com plete, ded ica ted m u lti-d is cip lin a ry tea m from th e SCIC to m eet in d ividu a l pa tien t n eeds 6.7 Es s en tia l fa cilities & equ ipm en t requ ired for ca re of th e acu te s pin a l cord in ju ry will be a va ila b le 6.8 All pa tien ts will receive com preh en s ive in form a tion a bou t th eir in ju ry a n d in d ividu a l p rogra m m es of ca re 6.9 Eva lu a tion of th e a cu te ca re progra m m e will be u n derta ken a t a greed in terva ls 7.0 Spinal Surge ry & Follow-up 7.1 Mu lti-p rofes s ion a l tea m s will work togeth er a cross dis cip lin es & loca tion s to a ch ieve optim u m a s s es s m en t, decis ion m a k in g, s u rgica l m a n a gem en t a n d ou tcom e 7.2 Sp in a l s u rgery & follow-u p ca re will be u n derta k en by a p p rop ria tely tra in ed & experien ced profes sion a ls 7.3 All pa tien ts will receive com preh en s ive in form a tion on th e propos ed s u rgica l procedu re a n d follow-u p trea tm en t 7.4 Eva lu a tion of clin ica l ou tcom es followin g s u rgica l in terven tion will be u n derta ken a t a greed in terva ls 8.0 Re habilit at io n 8.1 All pa tien ts will h a ve a ppropria te & tim ely a cces s to th e com plete, dedica ted m u lti-d is cip lin a ry tea m to m eet in d ivid u a l pa tien t n eeds 8.2 Clin ica l pa t h wa ys a n d tim e s ca les will be esta blis h ed for th e firs t a dm is s ion in rela tion to level a n d s everity of in ju ry 8.3 All pa tien ts will be in volved in a co-ord in a ted, pa tien t-cen tred, goa l p la n n in g p rogra m m e 8.4 Com preh en s ive pa tien t a s ses s m en t will be u n derta ken a t a greed in terva ls 8.5 Es s en tia l fa cilities & equ ipm en t requ ired for reh a b ilita tion will provided 8.6 All pa tien ts will receive com preh en s ive in form a tion on th e reh a bilita tion p roces s a n d th eir in d ivid u a l progra m m es 8.7 Eva lu a tion of th e reh a b ilita tion progra m m e will b e u n derta ken a t a greed in terva ls 9.0 Re integrat ion 9.1 Th e Sp in a l Cord In ju ry Cen tres will h a ve a com preh en s ive written policy a n d p rocedu re for dis ch a rge 9.2 Ap p rop ria te provis ion of a ccom m oda tion, equ ipm en t, pers on n el a n d fin a n ce will be m a de to m eet th e im m ed ia te n eeds of th e in d ividu a l to en s u re s a fe dis ch a rge 9.3 All pa tien ts will receive in form a tion on th eir role, righ ts a n d res pon s ib ilities in th e dis ch a rge p la n n in g p rocess 9.4 Th e Sp in a l Cord In ju ry Cen tres will h a ve a com preh en s ive written policy a n d p rocedu re for referra l to Socia l Services 9.5 In form a tion will be provided to a pp rop ria te com m u n ity pers on n el with in a n a greed tim e fra m e. 9.6 Th e Sp in a l Cord In ju ry Cen tres will h a ve a com preh en s ive written policy a n d p rocedu re for th e m a n a gem en t of dis ch a rge to in terim pla cem en ts 9.7 Th e Sp in a l Cord In ju ry Cen tres will h a ve a written policy a n d p rocedu re for th eir role in th e a p poin tm en t a n d p rovis ion of ca rers 9.8 All pa tien ts will be p rovided with in form a tion a n d a s s is ta n ce rega rd in g opportu n ities for edu ca tion, tra in in g & em p loym en t May

5 1 0.0 Re vie w 10.1 All pa tien ts d is ch a rged or referred for review by Sp in a l Cord In ju ry Cen tre will receive a pp rop ria te life-tim e follow u p from th e SCIC m u lti-dis cip lin a ry tea m 10.2 Defin ed s ys tem s for rou tin e review of a ll pa tien ts by SCIC a n d com m u n ity pers on n el will be es ta blis h ed 10.3 A proa ctive progra m m e a n d p rocedu re will be in p la ce to detect prob lem s a t th e ea rlies t opportu n ity 10.4 Th ere will be effective a n d tim ely com m u n ica tion between th e SCIC s a n d th e com m u n ity tea m s 10.5 SCIC will provide edu ca tion for com m u n ity pers on n el to s u pport SCI pa tien ts in th eir com m u n ity 10.6 All pa tien ts will receive in form a tion on th eir role & res pon s ib ilities in th e follow u p progra m m e 10.7 Lon g term ou tcom es for in d ividu a ls will be eva lu a ted u s in g va lid a ted ou tcom e m ea s u res Re -Adm is s ion 11.1 All pa tien ts will h a ve opportu n ity for rea dm is s ion (em ergen cy & pla n n ed ) to SCIC for m a n a gem en t of a con d ition rela ted to s pin a l cord in ju ry requ irin g SCI s pecia lis t in p u t, s u bject to a va ila b ility of co-loca ted services 11.2 Pre-a dm is s ion a s s es s m en t will be u n derta ken for a ll p la n n ed re-a dm is s ion s to SCIC 11.3 Selected procedu res will be u n derta ken in th e Ou t Pa tien t Depa rtm en t of th e SCIC 11.4 SCIC will provide s pecia lis t in p u t in to ca re of pa tien ts requ irin g oth er s pecia lis t trea tm en t 11.5 SCIC will provide s u pport for rou tin e procedu res u n derta ken by des ign a ted h os p ita ls 11.6 Selected procedu res will be u n derta ken in des ign a ted Da y Su rgery cen tres 11.7 All SCIC will h a ve des ign a ted beds for re-a dm is s ion 11.8 Th ere will be a n effective proces s for prioritis a tion of pa tien ts a wa itin g re-a dm is s ion to S CIC 11.9 All pa tien ts will receive com preh en s ive in form a tion on th e re-a dm is s ion p rocess a n d th eir in d ividu a l circu m s ta n ces Pae diatric Spinal Cord Injury Se rvic e s 12.1 Delivery a n d developm en t of a s ervice for ch ildren a n d for a doles cen ts with a s p in a l cord in ju ry will be co-ord in a ted by n a m ed pers on n el to en s u re th a t s ta n da rds a re m et 12.2 Th e s ervice for pa tien ts with s p in a l cord in ju ry in ch ild h ood will be des ign ed a n d developed a rou n d th e n eeds of th e ch ild a s a n in d ividu a l 12.3 Adequ a te res ou rces will be a va ila b le to a llow a s s es s m en t, a dm is s ion, in ves tiga tion a n d trea tm en t to a greed s ta n d a rds a t tim es a p propria te to th e ch ild s n eed 12.4 Mu lti-p rofes s ion a l tea m s will work togeth er, a cros s dis cip lin es a n d loca tion s, to a ch ieve optim u m decis ion m a k in g, trea tm en t a n d ou tcom e 12.5 Ca re will be provided for a ch ild with s pin a l cord in ju ry in a ccorda n ce with a greed n a tion a l gu idelin es 12.6 Th ere will be effective com m u n ica tion between a ll th os e res pon s ib le for th e ca re, a n d with th e ch ild a n d th eir fa m ily 12.7 Th ere will be a dequ a te facilities for on goin g ca re of ch ild ren a fter a cu te s pin a l cord in ju ry m a n a gem en t 12.8 Th ere will be a n a u d it process a ss es s in g ou tcom e, to in clu de effectiven es s of ca re, com plia n ce with gu idelin es a n d a n a lys is of a voida b le d is tress, dis a bility a n d dea th 12.9 Th e service for ch ildren with s pin a l cord in ju ry will a ctively en ga ge in res ea rch a n d developm en t of releva n t projects Au d it res u lts will in form th e b u s in es s cycle to a llow effective pla n n in g a n d developm en t of th e service for ch ild ren with s pin a l cord in ju ry, a ccord in g to n eed May

6 1 3.0 Educ ation and Trainin g 13.1 Th ere will be a progra m m e of con tin u in g edu ca tion for a ll pers on n el with in th e Sp in a l Cord In ju ry Cen tre to en s u re a proper u n ders ta n d in g of, a n d com p lia n ce with loca l protocols, n a tion a l gu idelin es, a n d in tegra ted ca re pa th wa ys, to en s u re com peten ce a n d a u n iform ly h igh s ta n d a rd of ca re 13.2 Th ere will be a lin ked p rogra m m e of edu ca tion for referrin g h os p ita ls, prim a ry ca re a n d em ergen cy services for a s pects of s pin a l cord in ju ry ca re a pp rop ria te to th eir p ra ctice, a n d for effective tea m work in g a n d m a in ten a n ce of m a n a ged clin ica l n etworks with in th e referra l a rea Tra in in g p rogra m m es will be effective a n d efficien t a n d deliver th e n ecess a ry level of com peten ce to a ll gra des of s ta ff Re s e arc h and De ve lo pm e n t 14.1 Developm en t of a n d p a rticipa tion in a p proved res ea rch a n d developm en t progra m m es in SCIC u n its will be en cou ra ged Info rm at io n Manage m e nt & Audit 15.1 A s tru ctu red, co-ord in a ted progra m m e of in d ivid u a l a n d loca l clin ica l a u d it will be developed, driven by pa tien t n eed a n d with dem on s tra b le pa tien t ben efits 15.2 Sp in a l Cord In ju ry Cen tres a n d in d ividu a l clin icia n s will con tribu te to th e developin g qu a lity a s s es s m en t/ a s s u ra n ce da ta b a s e 15.3 A join t da ta ba s e will be crea ted to prom ote u n iform ly h igh s ta n da rds of clin ica l ca re 15.4 Clin ica l a n d m a n a gem en t da ta from progra m m es of SCI ca re will in form clin ica l decis ion -m a k in g a n d s u p port clin ica l govern a n ce, a u d it a n d b u s in es s pla n n in g cycle a ccordin g to pa tien t n eed Man age m e nt of Patie nt s wit h SCI & Ot he r Signific ant Injurie s 16.1 All pa tien ts will h a ve a ppropria te & tim ely a cces s to th e com plete, dedica ted m u lti-d is cip lin a ry tea m from th e SCIC to m eet in d ividu a l pa tien t n eeds 16.2 Mu lti-d is cip lin a ry tea m s will work togeth er, a cross dis cip lin es a n d loca tion s to a ch ieve optim u m decis ion m a k in g, trea tm en t a n d ou tcom e 16.3 All fron t lin e s ta ff in p rim a ry a n d s econ da ry ca re will u n ders ta n d th e n eed for, a n d p rin cip les of, a p propria te m a n a gem en t of th e s pin a l cord in ju ry pa tien t a n d receive a dequ a te tra in in g in on wa rd referra l Ma n a gem en t a t th e a cciden t s cen e & du rin g tra n s fer to h os pita l will be provided in a ccorda n ce with n a tion a l & SCIC gu idelin es 16.5 Ma n a gem en t in th e a cciden t & em ergen cy depa rtm en t will be provided in a ccorda n ce with n a tion a l & SCIC gu idelin es May

7 TOPIC 1 PATIENT CENTRED CARE Int roduc t io n Recogn ition a n d res pect of th e in d ivid u a ls ca re n eeds a re of equ a l im porta n ce to th e a ppropria te clin ica l m a n a gem en t of th eir cord in ju ry. Im proved experien ces for th e pa tien t a n d th eir fa m ily th rou gh ou t th e pa tien t jou rn ey will in flu en ce pa tien t a d h eren ce a n d ou tcom e for th e progra m m e of SCI m a n a gem en t (See Ap pen d ix 1.1) St an dard 1.1 The s pinal c ord injury s e rvic e will be de s igned and de ve lope d aro un d t he needs of t he pat ie nt as an individual Crite ria Le ve l Crite ria De m onst ration of Adhe re nc e Evide nc e / Sourc e Con tin u ou s a s ses s m en t of pa tien t n eeds a n d ou tcom es will be u n derta ken on a n in dividu a l a n d grou p ba sis to in form progra m m e pla n n in g Sta ffin g requ irem en ts will be su fficien t to deliver a n h olistic pa tien t focu s sed progra m m e (S ee S t a nd a rd 8 ) All dedica ted SCIC sta ff will receive orien ta tion in to in terdisciplin a ry workin g a n d th e prin ciples of pa tien t focu s sed ca re Pa tien ts a n d fa m ilies will be em powered to becom e in volved in th eir h ea lth ca re a n d will h a ve t h e opp ortu n ity to provide feedba ck on th e qu a lity of ca re provided. Progra m m e a u dit Esta blish m en ts for a ll sta ff grou ps for a ll sta ges of pa tien t jou rn ey Tra in in g & a tten da n ce records s St an dard 1.2 Eac h patie nt s pe rc e pt ions, e xpe c t at ions, an d ne e ds will be c ons ide re d t o m axim is e t he be nefit from s pinal c ord injury s e rvic e c are. Crite ria Le ve l Crite ria De m onst ration of Adhe re nc e Evide nc e / Sourc e An h olistic a s ses sm en t of pa tien t n eed will be com pleted a s s oon a s pos sible a fter a dm is sion a n d reviewed on a regu la r ba s is (Appen dix 1.2) Ea ch pa tien t will h a ve a n a m ed key profes sion a l res pon sible for coordin a tin g th eir ca re a n d com m u n ica tin g with th e pa tien t a n d ca rers Pa tien ts a n d fa m ilies will be em powered to dea l with th e effects of th eir con dition th rou gh th e provision of releva n t in form a tion, in a n a ppropria te la n gu a ge, a n d th e opportu n ity to d is cu ss with th e releva n t m em ber of th e MDT Needs a s ses sm en t ch ecklist Pa tien t in form a tion lea flets a va ila ble May

8 St an dard 1.3 Pat ie nts will be c are d for in an appropriat e e n viro nm e nt and ac c o unt t ake n of t he ir s pe c ial needs, whic h will vary ac c ording t o t heir c linic al c onditio n Crite ria Le ve l Crite ria De m onst ration of Adhe re nc e Evide nc e / Sourc e Beds will be a va ila ble in a n a ppropria te loca tion a n d with a dequ a te sta ffin g su pp ort Sin gle bed a n d m u ltiple u ser wa rd beds High depen den cy beds (Acu te ca re) In ten sive Ca re beds (S ee S t a nd a rd 7 & 8 ) Ch ildren will n ot be rou tin ely ca red for in room s/ wa rds wh ere a du lts a re bein g trea ted except in exception a l circu m sta n ces (S ee S t a nd a rd 1 2 ) A sepa ra te ch ildren s fa cilit y will be m a de a va ila ble with fa cilities s pecifica lly design ed for u se by ch ildren a n d a dolescen ts (S ee S t a nd a rd 1 2 ) In ven tory of beds Bed occu pa n cy a u dit Ch ildren s fa cilities a va ila b le Adolescen t fa cility a va ila ble Na tion a l gu idelin es St an dard 1.4 The pat ie nt will be provide d wit h info rm at io n in orde r t o ac t ive ly partic ipate in t he ir h e alt h c are program m e In form a tion on th e service will be dis cu ssed & provided to th e pa tien t a n d th eir fa m ily in a n a ppropria te form a t Th e pa tien t will receive in form a tion a bou t th eir in ju ry, progn osis a n d progra m m e of m a n a gem en t delivered by th ose with su fficien t kn owledge & expertise a t th e a ppropria te tim e Dis cu ssion & a s ses sm en t of pa tien t in form a tion n eeds will be u n derta ken by th e design a ted m em ber of th e SCIC MDT a n d th e pa tien t a n d reviewed on a regu la r ba sis Pa tien t u n dersta n din g & reten tion of in form a tion will be discu ssed & a s ses sed by design a ted m em ber of MDT to a ssist pa tien t u n dersta n din g a n d pa rticipa tion All MDT decis ion -m a kin g m eetin gs will be u n derta ken in con ju n ction with th e in dividu a l a n d wh ere a ppropria te th eir fa m ilies Au dit ca se n ote docu m en ta tion Au dit ca se n ote docu m en ta tion May

9 St an dard 1.5 Pat ie nts re quiring urge nt c are or plac e d o n a waitin g lis t will re c e ive as s e s s m e nt/ t re at m e nt at t he o pt im um t im e fo r their c are Sta n da rds govern in g a ccess for a cu te trea tm en t ba sed on BASCIS s pecifica tion s will be esta blis h ed a n d a ch ieved Th e Na tion a l sta n da rds govern in g ou t-pa tien t a n d in -pa tien t wa itin g list a dm in istra tion will be a dh ered to Pa tien ts will be given th e opportu n ity to a gree a da te for th eir a dm is s ion a t th e tim e th e decision to trea t is m a de for elective su rgery or on goin g reh a bilita tion Th ere will be su fficien t fa cilities for both a du lts a n d ch ildren for s pin a l cord in ju ry pa tien ts to be a dm itted a t th e optim u m tim e for th eir ca re Tim es ca les for trea tm en t a greed a n d resou rced Tim es ca les com plied with (Clin ica l In dica tor) Im plem en ta tion of pla n n ed a dm is sion Absen ce of dela ys/ ca n cella tion (Clin ica l In dica tor) BASCIS Na tion a l ch a rter sta n da rds St an dard 1.6 The pat ie nt s c are will be provide d as c los e to their hom e as is prac t ic able and appro priat e Pa tien ts will on ly tra vel a s fa r a s it is n ecessa ry to rea ch th e level of expertis e requ ired for th e m a n a gem en t of th eir spin a l cord in ju ry Wh ere pa tien ts a re a dm itted to SCIC n ot in th eir loca lity, a requ est for tra n s fer to th eir loca l SCIC will be m a de with pa tien t a greem en t Clin ica l n etwork lin ks between th e des ign a ted SCIC a n d th e a ppropria te loca l fa cilities will en a ble on -goin g follow-u p a n d reh a bilita tion loca l to th e pa tien ts h om e (S ee S t a nd a rd 1 0 ) Clin ica l n etwork lin k s between th e design a ted SCIC a n d th e a ppropria te loca l fa cilities will en su re th a t trea tm en t of con dition s u n rela ted to SCI ca n be provided in th e pa tien ts loca lity (s ee S tand ard 11) Th e SCIC tea m will be rea dily a va ila ble for a dvice to oth er profes sion a ls on con tin u in g ca re for pa tien ts (s ee S t a n d a rd s 5,6,7,8,9,1 0 & 1 1 ) Esta blish ed clin ica l pa rtn ers h ip s between loca l ca re & des ign a ted SCIC s Referra l protocols docu m en ted & a va ila ble Esta blish ed clin ica l pa rtn ers h ip s between loca l ca re & des ign a ted SCIC s Gu idelin es a va ila ble Esta blish ed referra l pa th wa ys Sta keh older su rveys May

10 TOPIC 2 ORGANISATION OF SPINAL CORD INJ URY CARE Int roduc t io n Th e h igh ly s oph is tica ted, com plex n eeds of s pin a l cord in ju ry ca re requ ire im m ed ia te a cces s to s pecia lis ed s ta ff a n d fa cilities provided by cogn a te dis cip lin es. Con cen tra tion of fa cilities for provis ion of s pin a l cord in ju ry ca re lea ds to im p rovem en ts in pa tien t m a n a gem en t a n d ou tcom e th rou gh in crea s ed levels of expertis e a n d experien ce, in clu d in g s u b-s pecia lis a tion. Wh ere s ervices a re n ot ba s ed on th e s a m e s ite or with in th e s a m e orga n is a tion, th is m a y be a ch ieved th rou gh clin ica l pa rtn ers h ip work in g. St an dard 2.1 The needs of the s pinal c ord injure d populat io n will be m e t by ade quat e ly re s o urc e d Spinal Cord Injury Ce ntre s Ca re of a cu te s pin a l cord in ju red pa tien ts will be delivered in wa rds dedica ted to spin a l cord in ju ry a n d sta ffed by SCI tra in ed n u rses (S ee S t a nd a rd s 7 & 8 ) Th e n u m bers of sta ffed SCI bed s in su ch wa rds will be in a ccorda n ce with th e in ciden ce of SCI in th e Sou th of En gla n d & SCI rela ted re-a dm is s ion n eeds Th ere will be direct a ccess to dedica ted SCI ca re equ ipped a n d sta ffed to provide specia lised in ten sive m on itorin g a n d th era py (S ee S t a nd a rd 7 ), reh a bilita tion (s ee S t a nd a rd 8 ), rein tegra tion (s ee S t a nd a rd 9 ), Review (s ee S t a nd a rd 1 0 ), & Follow u p in terven tion s (s ee S t a nd a rd 1 1 ) Pa tien t Acces s Tea m (PAT) su rvey Bed sta tu s In ciden ce a u dit Referra l & wa itin g list a u dit St an dard 2.2 A s pe c ialis t t e am will be c ons tantly available to m e e t t he ne e ds of t he populat ion s e rve d Th e spin a l cord in ju ry progra m m e will be provided by m u ltidis ciplin a ry tea m s con ta in in g a dequ a te n u m bers of s pecifica lly tra in ed sta ff (S ee S t a nd a rd s 7, 8 & 1 2 ) Th ere will be 24h r, 7 da y/ week a ccess to Spin a l cord in ju ry a dvice/ ca re from a s pin a l cord in ju ry specia list (S ee S t a nd a rd 7 ) Appropria tely tra in ed a n d experien ced a n a esth etists will be a va ila b le a t a ll tim es for th e critica l ca re of com plex ca ses, in clu din g pa edia tric pa tien ts Appropria tely tra in ed a n d experien ced ph ys ioth era pists will be a va ila b le a t a ll tim es for em ergen cy respira tory ca re of a ll pa tien ts, in clu din g pa edia tric pa tien t s Sta ff esta blish m en ts & tra in in g records Con ta ct records Pa tien t & referrin g u n it su rveys Sta ff esta blish m en ts (job description s & person a l s pecifica tion s) & a ccredita tion Sta ff esta blish m en ts (job description s & person a l s pecifica tion s) & a ccredita tion RCA gu ida n ce Profes sion a l body gu ida n ce May

11 St an dard 2.3 Ade quate adm inis t rat ive s uppo rt will be available t o s e rvic e both t h e needs of pat ie nt s and c linic al inform at io n Adm in istra tive su p port will be a va ila ble for th e clin ica l sta ff workin g in th e wa rds, in clu din g pers on a l secreta ries/ a s sista n ts to con su lta n ts, clin ic, th ea tre a n d th era py a rea s to com plete a ll work n ot n eedin g specific clin ica l s kills GP s a n d oth er prim a ry ca re pra ctition ers will be a ppra ised of on goin g situ a tion with pa tien ts & receive com preh en sive in form a tion on pa tien ts dis ch a rge a n d follow u p a rra n gem en ts GP in form ed b y ph on e with in 24 h ou rs of a n y in -pa tien t dea th. In terim dis ch a rge su m m a ry given a t tim e of dis ch a rge & form a l dis ch a rge su m m a ry sen t to GP & referrin g h os pita l with in 10 da ys (S ee S t a nd a rd 9 ) Pa tien ts/ ca rers will h a ve a cces s to litera tu re a n d m u ltim edia in form a tion in th eir a ppropria te la n gu a ge in clu din g con ta cts for a ppropria te pa tien t su pport grou ps Clin ica l coders will receive tra in in g a n d in pu t from SCI specia lists to im prove th e qu a lity of da ta collected to serve clin ica l govern a n ce n eed s Su pp ort will be provided by th e h ost Tru st a u dit depa rtm en t to h elp des ign, collect a n d in terpret a u dit da ta In form a tion system s will be developed to en su re regu la r produ ction of clin ica lly releva n t reports to su pport clin ica l govern a n ce n eed s A & C & th era py a ss ista n ts esta blis h m en ts Docu m en ta tion a u dit Prin ted in form a tion List of su pport grou ps a n d con ta ct in form a tion Develop m en t of codin g role Tra in in g sem in a rs & a tten da n ce records Eviden ce of a u dit su pport, a n d cen tra l co-ordin a tion of a u dit Regu la r, clin ica lly releva n t, reports St an dard 2.4 Whe re c are of pat ie nts is not provide d wit hin the SCIC, c o-ordinat io n will exis t be t we e n units for t he ir e ffe c t ive m anage m e nt Na tion a l gu idelin es for th e trea tm en t of pa tien ts requ irin g spin a l cord in ju ry will be followed b y a ll sta ff in clu din g A&E sta ff, a m bu la n ce sta ff, prim a ry ca re sta ff a n d NHS Direct. (S ee S t a nd a rd s ) Em ergen cy or u rgen t su rgery sh ou ld n ot be dela yed for wa n t of a critica l ca re or spin a l bed in th e region a lly lin ked loca l SCIC. If n eces sa ry th e referrin g u n it sh ou ld en dea vou r to a rra n ge tra n s fer to a n a ltern a tive SCIC u n it eith er directly or by EBS. Wh ere th is is n ot possible, opera tion sh ou ld be perform ed, if a ppropria te, in th e lin ked spin a l su rgica l u n it, wh ilst post-opera tive pla cem en t is s ou gh t (S ee S t a nd a rd 7 ) Gu idelin es a u dit Wa itin g list & referra l a u d it May

12 TOPIC 3 COMMUNICATION BETWEEN PRIMARY, SECONDARY AND TERTIARY SERVICES Int roduc t io n Ca re of th e Sp in a l Cord In ju ry pa tien t will be provided by a n u m ber of h ea lth ca re profes s ion a ls ba s ed in prim a ry, s econ da ry a n d tertia ry s ervices. Effective com m u n ica tion is es sen tia l for th e co-ord in a ted p rovis ion of th e qu a lity life lon g h ea lth ca re progra m m e requ ired by th e pa tien t. St an dard 3.1 There will be e ffe c t ive c om m unic at io n be twe e n all le ve ls of c are and all s pe c ialitie s and profe s s ional gro ups Sp in a l Cord In ju ry Cen tres will h a ve a greed policies for com m u n ica tion a n d referra l criteria between prim a ry, secon da ry a n d tertia ry ca re a n d between differen t services with in ea ch SCIC Tru st (S ee S t a nd a rd s 5,6,8,1 1 ) Pa tien ts tra n sferrin g between h ea lth ca re fa cilities will be a ccom pa n ied by h igh qu a lity in form a tion, in clu din g a h ea lth records su m m a ry (with respon s ible clin icia n s n a m e), a m a n a gem en t or follow-u p pla n wh en a ppropria te a n d ra diologica l in form a tion / film s Prelim inary d is ch arge inform a tion w ill be m ad e available to general practitioners a t the tim e of d is charge. Com prehens ive d is charge inform ation w ill be s ent to GPs & referring hos pital w ithin 10 d ay s of d is charge Death of a patien t w ill be notified to General Practitioner & referring hos pital w ithin 24 hours. Written policies Au dit of tim elin es s a n d com pleten es s of in form a tion received a b ou t pa tien t s dia gn osis a n d m a n a gem en t a t tra n sfer. Au dit of prelim in a ry dis ch a rge n otes. Eviden ce of com plia n ce with 10 da y fin a l disch a rge su m m a ry. Regu la r a u dit of n otifica tion of dea th to GP. St an dard 3.2 There will be aware n e s s of s e rvic e s provide d by the Spinal Cord Injury Ce ntre s Th e SCIC will provide a directory of th e services a n d fa cilities provided by th e Cen tre wh ich sh ou ld in clu de th e followin g: List of m u ltidisciplin a ry tea m s, core m em bers, referra l a n d con ta ct in form a tion. Des cription of fa cilities for ou trea ch, reh a bilita tion, rein tegra tion, follow u p, a n d re-a dm is sion. In form a tion a bou t volu n ta ry a n d su pport grou ps for pa tien ts a n d ca rers, with con ta ct in form a tion Referra l gu idelin es for a cu te, reh a bilita tion a n d follow u p ca re Th e directory will be distribu ted to des ign a ted prim a ry a n d secon da ry h ea lth tea m s servin g th e popu la tion in th e SCIC ca tch m en t a rea Direct ory of services & referra l gu idelin es a va ila ble Sta keh older su rvey Distribu tion lists Au dit d istribu tion proces s Sta keh older su rvey St an dard 3.3 There will be e ffe c t ive planning and c o m m unic at ion abo ut th e s e rvic e s re quire d by an individual pat ie n t May

13 Agreed ca re pla n ba sed u pon a m u lti-dis cip lin a ry a s s es s m en t of in dividu a l n eeds with in volvem en t of th e pa tien t a n d/ or ca rer will be esta blis h ed (S ee S t a nd a rd 8 ) In form a tion a b ou t th e dia gn osis a n d ca re pla n will be provided to th e pa tien t, a n d/ or th eir fa m ily or oth er ca rer a s a ppropria te (S ee S t a nd a rd s 7, 8, 9 & 1 0 ) Com m u n ica tion between SCIC, prim a ry a n d secon da ry services a n d s ocia l services a bou t in dividu a l pa tien t n eeds in clu din g if n eces sa ry a rra n gem en ts for lon g-term a s ses s m en t a n d tra n s fer will u se a greed criteria (S ee S t a nd a rd 9 ) S CIC s w ill have ava ilable com prehens ive and com prehens ible patien t inform ation about s pinal cord injury acces s ible both to patien ts and fam ilies a nd w ill m ak e a vailable a profes s ional s taff m em ber to explain its conten t. Docu m en ted ca re pla n with in th e ca se records, in clu din g a n eeds a s ses sm en t. Ca se n ote & docu m en ta tion a u dit Ca se n ote & docu m en ta tion a u dit Eviden ce of pa tien t litera tu re a va ila ble Eviden ce of a n a m ed key worker St an dard 3.4 The us e of inform at io n t e c hnology, including e le c t ro nic im age trans fe r will be m axim is e d as a s uppo rt to c ons ult at ion, c om m unic at io n and de c is ion m aking / 3 A com m on da ta set will be u sed to tra n s fer requ ired in form a tion electron ica lly between SCIC, prim a ry, secon da ry & tertia ry services a n d com m is sion ers (Appen dix 3.1) Agreed tim es cales for cons ultation w ill be im plem ented betw een S CIC and prim ary, s econd ary and tertiary s ervices (S ee S t a nd a rd s 5,6,7,8,9,1 0 & 1 1 ) All da ta a n d proces ses for in form a tion tra n sfer will com ply with n a tion a l sta n da rds a n d loca l policy (See Appen dix 3.1) SCIC will provide edu ca tion to design a ted lin k services re: in form a tion requ ired a n d da ta tra n sfer process Com m on da ta set a va ila ble Docu m en ta tion a u dit Policy & gu idelin es a va ila ble In form a tion & tra in in g sch edu les a va ila ble Na tion a l Gu idelin es (eg. In form a tion sta n da rds, Ca ldicott) May

14 TOPIC 4 MANAGEMENT OF THE SPINAL CORD INJ URY SERVICE Int roduc t io n Sp in a l Cord In ju ry s ervices will va ry in th eir m a n a gem en t s tru ctu res, depen den t on t h e con figu ra tion with in th e h os t Tru s t. All m odels requ ire a m a n a gem en t s tru ctu re to en s u re th a t th e u n it is a ble to provide th e resou rces a pp rop ria te to th e service requ ired a n d t h a t it will com p ly with is s u es of clin ica l govern a n ce. St an dard 4.1 Spinal Cord Injury s e rvic e s will have an e ffe c t ive m anage m e nt s t ruc t ure wit h c le ar line s of ac c ount abilit y and re s po ns ibilit y Ea ch SCI service will h a ve a n iden tified officers respon sible for its clin ica l & bu s in es s m a n a gem en t. Th ose in dividu a ls will h a ve clea rly defin ed resp on s ib ilities a n d lin es of a ccou n ta bility Th ere will be a tea m to su p port th e iden tified officers with clea r lin es of a ccou n ta bility, wh ich will in clu de:- Lea d for iss u es of clin ica l govern a n ce Lea ds for Nu rsin g a n d AHP s Lea d for Fin a n ce, Con tra cts a n d pla n n in g Lea d for Hu m a n resou rces (pers on n el) Lea d for in terdisciplin a ry in terfa ces Lea d for tra in in g a n d edu ca tion (S ee S t a nd a rd 1 1 ) SCIC will h a ve a stru ctu re of m a n a gem en t th a t will in corpora te m edica l, n u rs in g, AHP s, A & C services a n d h otel services SCIC will h a ve a defin ed bu dget a n d a ccou n tin g proces s ba sed on th e service con tra cts Th e SCIC progra m m e will con tra ct th rou gh its releva n t m a n a gem en t stru ctu re (to in clu de pa ren t Tru st con tra ctin g sta ff) with a ppropria te com m iss ion in g a u th orities Th e SCIC will h a ve a ppropria te a cces s to th e Ma n a gem en t of Hu m a n Resou rces to en su re com plia n ce with Term s a n d Con dition s of Service for its m em bers of sta ff SCIC will h a ve a clea r proces s for is su es of clin ica l govern a n ce Sta ffin g - Tea m Workin g & cover, a s ses sm en t & a p pra isa l Orga n isa tion of Morbidity a n d Morta lity & oth er clin ica l a u dit m eetin gs Risk s, in ciden ts, a n d n ea r m iss reportin g & review Com pla in ts a n d Litiga tion Policin g of Gu idelin es, protocols a n d Sta n da rds Progra m m es will requ ire t o dem on stra te a n effective m a n a gem en t proces s for in terdis cip lin a ry tea m Pa ren t Tru st Ma n a gem en t Stru ctu re J ob des cription s Tru st/ Directora te/ Progra m m e m a n a gem en t stru ctu re Ma n a gem en t Tea m Stru ctu re a n d Nom in a ted Officers Fin a n cia l Sta tem en ts Con tra ct s & defin ed proces s Agreed Hu m a n Res ou rces Su pport Appra isa l stru ctu re & process IPR records/ J ob pla n s Du ty rota / cover a rra n gem en t s Clin ica l a u dit & risk m a n a gem en t m in u tes a n d Atten da n ce record s Con ta ct s/ Bu dget Nom in a ted Officers May

15 TOPIC 5 ACCESS, ASSESSMENT & DIAGNOSIS. Int roduc t io n Wh en pa tien ts s u s ta in a s pin a l cord in ju ry, th eir con d ition, its s everity, a n d a n y a s s ocia ted prob lem s m u s t be a pprop ria tely a s s es s ed a n d em ergen cy trea tm en t com m en ced. Pa tien ts with es ta blis h ed s pin a l cord in ju ry p res en tin g in prim a ry or s econ da ry ca re with prob lem s rela ted or u n rela ted to th eir cord in ju ry a ls o requ ire com preh en s ive a s ses s m en t of th e prim a ry prob lem a n d poten tia l con s equ en ces in rela tion to th eir cord in ju ry Referra l to th e m os t a ppropria te s ervice a ccordin g to exis tin g p rotocols a n d gu idelin es is requ ired a ccordin g to n eed. St an dard 5.1 All front line s t aff in prim ary and s e c o ndary c are will unde rs t and t he ne e d for, and principle s of, appropriate m anage m e nt of the s pinal c ord injury pat ie nt and re c e ive ade quat e t raining in o nward re fe rral Gu idelin es will be a va ila ble for A & E sta ff a n d oth er s ou rces of referra l describin g on wa rd referra l of pa tien ts a ccordin g to th e pa tien ts con dition Doctors wh o a re resp on sible for th e m a n a gem en t of em ergen cies, in th e field (eg. BASICS doctors) or A&E will a tten d cou rses wh ich in clu de th e em ergen cy ca re of a pa tien t with a n a cu te s pin a l cord in ju ry (S ee S t a nd a rd 7 ) Pa ra m edics & oth er Pre-h ospita l h ea lth ca re sta ff will receive tra in in g & edu ca tion in th e em ergen cy ca re of a pa tien t with a n a cu te spin a l cord in ju ry (S ee S t a nd a rd 6 ) Pa ra m edics & oth er a m bu la n ce em ergen cy sta ff will receive u pda te tra in in g a ccordin g to n a tion a l & SCIC gu idelin es Ava ila bility of gu idelin es Certifica tes of a tten da n ce a t releva n t cou rses. New sta ff will a tten d th e cou rses with in th e first 3 m on th s of a pp oin tm en t. New A & E a m bu la n ce sta ff will receive a ccredited tra in in g in cu rren t best pra ctice with in n a tion a l gu idelin es Accredita tion of con tin u in g edu ca tion IHCD a ccredited tra in in g to J RCALC gu idelin es BASCIS & PHTLS tra in in g cou rses J RCALC gu idelin es IHCD a ccredited tra in in g PDP progra m m es May

16 St an dard 5.2 Spinal Cord Injury Ce n t re s will have and dis s e m inat e c rit e ria for c on s ult at io n and for adm is s ion Gu idelin es for con su lta tion with a SCI specia list will be a va ila ble to a ll sta ff in referrin g h ospita ls a n d com m u n ities Gu idelin es for a dm is sion to a SCIC will be a va ila ble t o a ll sta ff in referrin g h ospita ls a n d com m u n ities Gu idelin es a va ila ble Ou trea ch a u dit Gu idelin es a va ila ble Ou trea ch a u dit SCIC ou trea ch service specifica tion Sh effield Ou trea ch service & a u dit da ta SCIC ou trea ch service specifica tion Sh effield Ou trea ch service & a u dit da ta St an dard 5.3 Adm is s ion or trans fe r t o a SCIC for t re at m e nt of an ac ute s pinal c ord injury will be c om ple t e d within t he agre e d tim e s c ale, and all ot he r adm is s ions will be in ac c ordan c e wit h Natio nal Wait in g Tim e St andards / 2 Pa tien ts with dia gn osed a cu te spin a l cord in ju ry will b e a dm itted or tra n s ferred with in a defin ed tim e in terva l (S ee S t a nd a rd 6 ) Na tion a l Wa itin g Tim es sta n da rds for elective a dm is sion s will be m et (S ee S t a nd a rd 1 1 ) Referra l & a dm is sion a u dit Wa itin g tim e a u dit Na tion a l Ch a rter sta n da rds St an dard 5.4 Curre n t inform at io n abo ut o ut -pat ie n t wait s and be d-s tat e will be re adily available t o re fe rring c linic ians and re c e iving s urge ons / 2 SCIC will provide con tin u ou s a cces s to con tem p ora ry in form a tion a bou t a va ila bility of SCI ou t-pa tien t a ppoin tm en ts, a n d in -pa tien t beds for a cu te ca re, reh a bilita tion & re-a dm is sion. Bed a va ila bility figu res May

17 TOPIC 6 ACUTE CARE Int roduc t io n Th e in itia l m a n a gem en t of a n a cu te s pin a l cord in ju ry is critica l to th e even tu a l p rogn os is a n d ou tcom e for th e pa tien t. Ma n a gem en t a t th e s cen e of th e in ju ry, tra n s fer a n d a dm is s ion to A & E a n d s u bs equ en t referra l a n d tra n s fer to a Sp in a l Cord In ju ry Cen tre (SCIC) is p rovided by n u m erou s a gen cies. App rop ria te a n d tim ely m a n a gem en t requ ires a co-ord in a ted ca re pa th wa y, provid in g p rotocols a n d gu idelin es for th e m u lti-a gen cy a n d m u lti-d is cip lin a ry tea m s in volved. St andard 6.1 Mult i-dis c iplin ary t eam s will work t oget he r, acros s dis c ipline s and loc at ion s t o ac h ie ve opt im um de c is ion m akin g, t re at m e nt and out c om e Pa tien ts with a cu te spin a l cord in ju ry will be ca red for by m u ltidis ciplin a ry tea m s con ta in in g a dequ a te n u m bers of s pecifica lly tra in ed sta ff. Th e tea m sh a ll in clu de a m bu la n ce sta ff, pre-h os pita l ca re doctors, A & E & SCIC tea m s (S ee S t a nd a rd 8 ) A com m on d a ta s et w ill be us ed to trans fer required inform ation electronically betw een pre-hos pital, A & E & S CIC team s Agreed tim es cales for cons ulta tion w ill be im plem ented betw een S CIC and A & E d epartm en ts Sou th of En gla n d SCIC s will m eet a n n u a lly to review Policy & Pra ctice Sta ff esta blish m en ts Tra in in g progra m m es & a tten da n ce records Com m on da ta set Docu m en ta tion & sta keh older a u dit Review m eetin g m in u tes St an dard 6.2 Man age m e nt at th e ac c ide nt s c e ne & during trans fe r t o h os pit al will be provide d in ac c ordance wit h nat io nal & SCIC guide lines Crite ria Le ve l Crite ria De m onst ration of Adhe re nc e Evide nc e / Sourc e Agreed protocols for id entification of patients w ith s us pected S CI w ill be im plem en ted (S ee Append ix 6.1*) Agreed protocols for s pine in line care & card io-res pira tory s tabilis a tion at s cene & d urin g tra ns port (S ee Append ix 6.1 *) Patien t w ill be transferred to neares t A & E d epartm en t or d es ignated traum a centre. Con firm ed isola ted SCI will be tra n s ferred to n ea rest SCIC with a va ila b le fa cilities, with preferred provider a s first option Am bu la n ce service clin ica l a u dit & developm en t of releva n t key clin ica l perform a n ce in dica tor set Am bu la n ce service clin ica l a u dit Referra l a u dit J RCALC gu idelin es US n a tion a l clin ica l gu idelin es J RCALC gu idelin es BASICS/ PHTLS/ ATLS gu idelin es Pa tien t will be tra n sferred to A & E by Air a m bu la n ce if a va ila ble or roa d a m bu la n ce tra vellin g a t 30 m.p.h. May BASCIS sta n da rds

18 St an dard 6.3 Man age m e nt in th e ac c ide nt & e m e rge nc y de part m e n t will be provide d in ac c o rdanc e wit h n at io nal & SCIC guide lines Agreed protocols for s pine in line care & card io-res pira tory s tabilis a tion w ill be im plem ented (S ee Append ix 6.2) Patien t to rem a in on long board or vacuum m a ttres s or other s pinal im m obilis a tion d evice for as little tim e as es s en tial for initia l em ergency clinical m anagem en t Agreed protocols for pa tien t as s es s m en t (includ ing im aging) w ill be im plem en ted (S ee Append ix 6.3) Im a gin g s hould includ e the w hole s pine & other injured areas Pa tien ts on lon g b oa rd s will be a ssessed a n d tra n s ferred wh ere pos sible im m edia tely a fter t h e prim a ry su rvey Protocols a va ila ble Au dit of clin ica l pra ctice Protocols a va ila ble Au dit of clin ica l pra ctice Am bu la n ce Service / A & E depa rtm en t clin ica l a u dit ATLS protocols J RCALC gu idelin es BASCIS sta n da rds BASCIS sta n da rds ATLS protocols Ea st/ US gu idelin es J RCALC gu idelin es St an dard 6.4 All front line s taff will unde rs t an d t he need for and principle s of appro priat e pat ie nt m anage m e nt and re c e ive ade quate trainin g in on ward re fe rral Crite ria Le ve l Crite ria De m onst ration of Adhe re nc e Evide nc e / Sourc e Agreed guid elines w ill be available to am bula nce & A & E s taff d es cribin g im m ed iate m a nagem en t and on w ard referral of patients s us taining a s pinal cord injury (S ee Append ix 6.1) Am bu la n ce sta ff, oth er pre-h ospita l ca rers & A & E doctors wh o a re res pon s ible for th e m a n a gem en t of em ergen cies will a tten d cou rses wh ich in clu de th e em ergen cy ca re of a pa tien t with an a cu te spin a l cord in ju ry Edu ca tion a l pa rtn ersh ips will be developed between Am bu la n ce Services, A & E depa rtm en t s a n d des ign a ted Spin a l Cord In ju ry Cen tres Ea ch Spin a l Cord In ju ry Cen tres will iden tify tra in in g & edu ca tion sta ff a t a m bu la n ce Tru sts in it s ca tch m en t a rea to develop edu ca tion progra m m es Gu idelin es a va ila ble Au dit of clin ica l pra ctice Tra in in g records Edu ca tion a l progra m m es esta blis h ed between design a ted lin k h ospita ls Register of iden tified tra in in g officers J RCALC gu idelin es ATLS protocols J RCALC gu idelin es ATLS protocols BASIC tra in in g gu idelin es May

19 St an dard 6.5 Re fe rral & Clinic al pathways and t im e s c ale s will be e s t ablis hed in re lat io n t o s e ve rit y of injury Referra l & Clin ica l pa th wa ys will be m a pped & docu m en ted. Best pra ctice is a dm is s ion of th e a cu te SCI pa tien t to th e design a ted lin k SCIC from th e A & E depa rtm en t a s s oon a s poss ible a fter in ju ry, provided th e pa tien t is fit to tra vel Clin ica l pa rtn ers h ips for referra l & m a n a gem en t will be developed between design a ted A & E depa rtm en ts a n d design a ted SCIC s A & E con su lta n t will con ta ct design a ted SCIC im m edia tely for a dvice & n otifica tion of in ju ry A Spin a l Cord In ju ry con su lta n t will a lwa ys be a va ila ble to a dvise A & E u n it A sta n da rdised SCIC referra l form will be com pleted by A & E depa rtm en t (See Appen dix 6.4) Pa tien t depen den cy will be a ssessed u s in g critica l ca re criteria to determ in e pa tien t su pport requ ired Agreed protocol for tra n s fer of pa tien t to a ppropria te u n it (See Appen d ix 6.5) Mode of pa tien t tra n s fer J ou rn ey tim e < 2 h ou rs Tra n s fer by roa d a m bu la n ce J ou rn ey tim e > 2 h ou rs Tra n s fer by a ir a m bu la n ce If bed n ot a va ila ble in des ign a ted u n it, referrin g h ospita l will con ta ct em ergen cy bed service Em ergen cy bed service will im plem en t a greed protocol for referra l a n d a dm is sion to oth er SCIC SCIC will provide in form a tion on bed a va ila bility for differen t ca tegories of a cu te SCI to EBS on da ily ba sis Referra l & Clin ica l pa th wa ys a va ila ble Design a ted lin k u n its Referra l a u d it Sta keh older a u dit Docu m en ta tion a u dit Sta keh older a u dit Docu m en ta tion a u dit Docu m en ta tion a u dit Referra l a u d it Referra l a u d it & wa itin g tim es Bed sta tu s a va ila ble NSIC ga p a n a lysis York Review In ten s ive Ca re Society gu idelin es EBS m a n a gem en t protocol May

20 St an dard 6.6 All patie nt s will have appropriat e & t im e ly ac c e s s t o t he c om ple t e, de dic ate d m ulti-dis c iplinary t e am from th e SCIC to m e e t in dividual pat ie nt needs Th e a cu te ca re will be provided by a co-ordin a ted m u ltidis ciplin a ry tea m of a ppropria tely tra in ed profess ion a ls Th e core SCIC Tea m sta ff n u m bers, qu a lifica tion s a n d experien ce m u st be a dequ a te to m eet th e pa tien t ca se loa d (in clu din g ITU & HDU sta ff) (S ee S t a nd a rd s 8 & 1 3 ) Ea ch profession a l grou p will work t o th eir profession a l sta n da rds of ca re (S ee S t a nd a rd s 8 & 1 3 ) In a ddition to th e core clin ica l tea m, th ere will be esta blis h ed a ccess to in pu t for a cu te ca re from oth er dis ciplin es a s requ ired:- Im a gin g, s peech & la n gu a ge th era p y, dia tetics, ph leb otom y, ch a pla in cy, pa tien t a dvoca tes, p eer cou n sellors Esta blish ed referra l pa th wa ys will m a ke a va ila ble oth er s pecia lty a dvice or in terven tion of su fficien t expertise for th e ca re of a cu te SCI pa tien t Ca rdiology, Ga stro-en terology, ENT, Pla stic Su rgery, Gen era l Su rgery, Va s cu la r Su rgery, Ha em a tology, Pa ed ia trics, Ps ych ia try, Sp in a l su rgery, Neu rosu rgery, Orth opa edic su rgery, An a esth etics, In ten sive & Respira tory Ca re expertise Pa tien ts su sta in in g spin a l cord in ju ry in con ju n ction with oth er sign ifica n t h ea lth n eeds (e.g. s ign ifica n t bra in in ju ry, ca rd ioth ora cic in ju ry) a n d th ose wh o ca n n ot be a dm itted im m edia tely to a n a cu te SCI bed (beca u se th ere is n o s u ch bed a va ila b le) will h a ve a cces s to th e SCIC MDT th rou gh a n a cu te ou trea ch progra m m e from th e design a ted spin a l cord in ju ry cen tre to th e a ppropria te loca tion (S ee S t a nd a rd 1 6 ) Ca re pa th wa ys docu m en ted Sta ff esta blish m en ts Sta ff esta blish m en ts Referra l pa th wa ys a va ila ble Referra l pa th wa ys a va ila ble Referra l & ou trea ch a u dit May