Guidleines for Acute Spinal Injury Patients

Guidleines for Admission, discharge and follow up of acute Spinal Injury patients (Neurological Injury above T6, <72 hours post-injury) admitted to Christchurch Hospital, CDHB.

Admissions

Admission to Intensive Care

All ventilated spinal +/- multiple trauma patients.

Non ventilated spinal +/- multiple trauma patients, where the duty Intensive Care specialist and other specialists including the Spinal Injury Specialist agree that the patient would benefit from admission to intensive care.

  • Responsibility for ongoing care: Intensive Care Team
  •  

Admission to Orthopaedic Trauma Unit

 
Non ventilated spinal +/- multiple trauma patients where the spinal Injury specialist and other specialists including the duty Intensive Care Specialist agree that the patient does not require admission to Intensive Care.

Where appropriate and agreed, such patients may be reviewed regularly by the Intensive Care Team via the Outreach service.

  • Responsibility for ongoing care:

      • Spinal Injury Team and Orthopaedic Trauma Service

      • Support provided by Intensive Care Outreach Service

Discharges

Discharge to Burwood Hospital

 
Where the Duty Intensive Care Specialist and the Spinal Injury Specialist agree that the patient no longer requires Intensive Care, and that it is appropriate for the patient to be transferred to Burwood Spinal Unit for ongoing rehabilitation.

  • Responsibility for ongoing care:  Spinal Injury Team
  •  

Discharge to Orthopaedic Trauma Unit

 
Where the Duty Intensive Care specialist and the spinal Injury specialist agree that the patient's condition is such that the patient no longer requires intensive care, and that it is not appropriate for the patient to be transferred to the Burwood Spinal Unit.

Where appropriate and agreed, such patients may be reviewed regularly by the Intensive Care Team via the Outreach service.

  • Responsibility for ongoing care

      • Spinal Injury Team and Orthopaedic Trauma Service

      • Support provided by Intensive Care Outreach Service

 

Protocol for Transfer of Spinal Injury Patients to Canterbury to Canterbury District Health Board

 

Patient TypeDefinitionTreatment
Hot Patients
[<24hrs post-injury]
Any spinal injury patient with neurological injury coming to CDHB within 24 hours of injury.Trauma Call involving usual participants, plus spinal/Orthopaedic Teams.

 

Warm Patients
[>24hrs but <72hrs]
High Injury

 

 

 
Low Injury

 

Any patient with significant neurological injury above T6, coming to CDHB > 24 hours but <72 hours post-injury.
[Whom has had a minimum of complete spinal plain radiology]

Patients with significant neurological injury T6 and below who present > 24 hours and <72 hours post-injury, who have had a minimum of complete spinal plain radiography.  If incomplete, then manage as for hot/warm patient.

Trauma call [and degree of ED placement] is at the discretion of ED consultant in consultation with Spinal Injuries Unit consultant.  Tentative destination must be organised prior to transfer.

NB:  If patient transferred directly to destination, then mandatory assessment by the surgical team is also required on patient's arrival at unit.

As for cold patients

Cold Patients
[>72 hrs post-injury]

Any spinal injury patient > 72 hours post-injury.

NB:  If patient referred from secondary facility, then ED placement is at the discretion of the ED consultant.

Specific destination confirmed prior to transfer.
Patient is transferred via ED directly to destination, [unless features of significant patient instability].
NB:  For 'cold' patients accepted for transfer to ICU or OTU, decisions about alternative venues of care are to be made after transfer to those units, not in ED.

 

As with all successful transfers good communication is key.
If Intensive Care is the accepting service, please ensure that the following have been notified:

    • ED consultant [ext 81900]

    • Spinal consultant [via Burwood Operator]

    • Duty Manager – pager 8304

    • Intensive Care ACNM – pager 8888

    • CTC Medical – Pager 5265

    • CTC surgical – Pager 5266

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Page last reviewed: 14 May 2014
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