Abstract
Spinal pathologies requiring spinal/neurospinal unit’s input/opinion from tertiary centres for their management are initially admitted to DGHs. The referral is made by mailing radiographs with clinical details to the on-call registrar who gets back with a management plan. This arrangement is fraught with delays at various levels having an impact on patient care, financial and medico-legal implications. We discuss these issues between index DGH (Poole General Hospital) and its tertiary referral centres.
To review the existing management of spinal injury admissions at our hospital, analyse critical/adverse incidents and to identify areas for improving patient care.
A comprehensive retrospective review of all spinal admissions/referrals made to tertiary centres over 6 months was undertaken. Twenty eight of the 64 admissions warranted referrals. A structured proforma was used to document the time of admission, time of booking and performing scans, time of referral & response from tertiary centre and time of transfer from hospital notes and delays at each level were critically analysed.
Seven of the 28 referrals had either neurodeficit or spinal instability. Common issues were delay in obtaining CT/MRI scans (av 2.5 days), delay due to reporting/failing to act on results (av 1.8 days), delays due to missing/lost in transit’ scans (av 1.5 day), delay in obtaining opinion (av 4 days) and non-availability of bed for transfer (av 5.5 days). There was 1 mortality and 5 other complications while awaiting transfer. The financial costs incurred were approximately £73,000 & loss of 246 patient-days.
Training on induction day, implementation of spinal care pathway and diligent documentation/communication coupled with succinct referral were strictly enforced following this study. The website www.neurorefer.co.uk was set up by Wessex neurological centre to streamline referrals and enhance efficiency. This website has now grown into a national secure referral portal incorporating other referral centres.
Correspondence should be addressed to Editorial Secretary Mr ML Costa or Assistant Editorial Secretary Mr B.J. Ollivere at BOA, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England; Email: mattcosta@hotmail.com or ben@ollivere.co.uk
