Review of Patient Transfers from Spinal Surgery to the Spinal Injuries Unit

Abstract

Introduction To review the length of time patients are awaiting spinal injury reviews on the spinal surgery ward and awaiting beds on the spinal injuries unit. Materials and Methods A list of all spinal surgery patients with a spinal injuries episode within the same spell during the period 01/04/12 to 26/11/14 were gained by coding ( n = 37). Three patients were excluded from the data (one under neurosurgery, two were transferred from the spinal injuries unit (SIU) and were both discharged from the spinal surgery ward) ( n = 34). Data was obtained via a case note review. Results The mean number of days patients were awaiting a SIU bed (calculated from spinal injuries review to transfer) was 19 (+/−14). The maximum time waiting on the spinal surgery ward was 39 days, and one patient waited 48 days for a ventilator bed. The later the admission the longer patients were waiting, with a positive correlation but this was not significant (r = 0.28, p = 0.18). The mean waiting time was 9 days in 2012, 17 days in 2013 and 24 days in 2014. There was a positive correlation between the length of time patients were awaiting a SIU bed and their length of spinal injuries stay (r = 0.105, p = 0.39). The mean time awaiting a spinal injuries review was 5.9 days. However often there was limited documentation regarding how patients were referred and so was not clear when referrals were received by the spinal injuries team. Two patients had no documented review before transfer. The most frequent type of injury which resulted in patients requiring transfer for rehabilitation was fracture (44%), followed by infection (29%). 47% of injuries were in the thoracic spine. 71% received surgery during their admission. Conclusions This review shows patients are waiting considerable amounts of time awaiting SIU beds and the delays are increasing each year. Delays cause significant implications for patients such as psychological issues and risk of complications including pressure sores, contractures and infections, all of which can impact on functional outcomes. Delays are a high cost to the NHS (the cost of a critical care bed is over £800 more than a ventilated SIU bed). Further work can be performed reviewing reasons for delays and to look at delays in SIU discharges. Patients could benefit from an increase in spinal injury reviews while beds are awaited. An audit on the management of SCI patients while they are on an orthopaedic ward could ensure care meets current recommendations.