Access to Care Study: Understanding the first 24 hours to improve outcomes after spinal cord injury

Release date: 31-May-2013

Organisation: The Spinal Cord Injury Network, Sydney, NSW

The Spinal Cord Injury Network is a proud partner on an NHMRC grant awarded in November 2011 to investigate the factors that determine clinical outcomes and well being of people in the first 24 hours after sustaining a spinal cord injury.

“Right care, right time, right place: improving outcomes for people with spinal cord injury through early intervention and improved access to specialised care” (“Access to Care” for short), is investigating in detail the earliest part of the clinical journey for all patients with suspected or proven traumatic spinal cord injury, from scene of injury to definitive diagnosis and specialised treatment in a spinal cord injury unit in New South Wales and Victoria. The primary hypothesis to be tested is that commencement of specialised spinal cord injury care within 24 hours of injury leads to better outcomes on a range of measures, than later commencement.

Principal Investigator Associate Professor James Middleton has put together a multi-disciplinary team to conduct the research, which, combined, offer a breadth of expertise in pre-hospital care, injury epidemiology, trauma management and rehabilitation, health systems analysis and ongoing disability support. Research Manager Lisa Sharwood has completed an injury epidemiology PhD and Masters in Public Health, having begun her career as a Critical Care nurse. Lisa has so far facilitated the first major achievement, which was ethics approval in December 2012 from the Cancer Institute/Population Health Human Research Ethics Committee to allow the prospective study in NSW. She has also been responsible for facilitating the participation of all major trauma hospitals, ambulance and spinal cord services, and managing affiliated study staff. Lisa has been working with a biostatistician to conduct a detailed retrospective analysis of a large linked data set from NSW Ambulance, looking at all patients retrieved by ambulance with a traumatic spinal cord injury, with detailed information on the entire journey of patients through the healthcare system in NSW, from the emergency 000 call through to rehabilitation, discharge or death. The analysis aims to describe pathways of care, specifically focussing on time delays or efficiencies in getting these patients to specialist care in a timely manner, and the appropriate use of ambulance protocols.  

Research Fellow Dr Cameron Gosling joined the team in October 2012, and is working half time on this project in Victoria, coordinating sites and ethical approval. He will then oversee the data collection. Research Officer Luciano Melo joined the Sydney team in January 2013 to assist Lisa with the arduous task of ethics applications, and will commence manual data collection and patient communications once all sites are ethically approved. He will be also conducting the follow-up telephone interviews with participants at 6, 12 and 18 months post-injury, to assess their outcomes across a variety of well known tools, including quality of life indicators, daily functioning and mental health.

The Access to Care research team has commissioned Professor Richard Sinnott and his eResearch colleagues at The University of Melbourne to build a web-based platform to connect the data collected, enabling direct tablet entry of real time data into this database. Professor Sinnott has previously built security orientated web-based databases facilitating multisite studies with their data entry and analysis even across up to 15 countries participating. The sophisticated technology allows the secure input of data from a wide range of sources, the automated coding of sensitive and identifying information to protect research participants, with the facility to allow researchers to interrogate and analyse these large datasets.

Ultimately, Associate Professor Middleton and his team are aiming to analyse health service delivery both across and between the states of New South Wales and Victoria, and to understand the early care pathways that provide optimal outcomes for the acute spinal cord injury patient. We look forward to following the progress of this study…

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