A geospatial examination of specialist care accessibility and impact on health outcomes for patients with acute traumatic spinal cord injury in New South Wales, Australia: a population record linkage study

BMC Health Services Research, 2021 · DOI: https://doi.org/10.1186/s12913-021-06235-4 · Published: March 2, 2021

Spinal Cord Injury Healthcare Public Health

Simple Explanation

This study looks at how easy it is for people in New South Wales, Australia, who have suffered a traumatic spinal cord injury (TSCI) to get specialist care. It uses maps and location data to see if where someone is injured affects how quickly they get to a specialist spinal cord injury unit (SCIU). The study found that even if people were injured close to a specialist unit, they weren't always taken there directly. This delay can lead to slower treatment and more complications. The researchers suggest that making sure people get to the right place quickly could improve their health outcomes and save the health system money. By using detailed location data, the researchers discovered that a significant number of patients are initially taken to non-specialist hospitals, even when a specialist SCIU is nearby. This detour delays necessary surgery and increases the risk of developing further health issues during their hospital stay.

Study Duration

2013-2016 (3 years)

Participants

316 patients aged ≥16 years with incident TSCI in NSW

Evidence Level

Not specified

Key Findings

1
Over half (53%) of patients were injured within 60 minutes of a SCIU, but only 28.6% were directly transferred.
2
Direct transfers to SCIU resulted in earlier operative intervention (median 12.9 hours) compared to indirect transfers (median 19.5 hours).
3
Patients experiencing indirect transfer to SCIU had an increased risk of developing inpatient hospital complications compared with patients transferred directly to SCIU.

Research Summary

This study investigated the impact of geospatial variables on access to specialist care for patients with acute TSCI across NSW and revealed that despite over half of the patients being injured within a 60-min road travel time of a SCIU, less than 30% of them experienced a direct SCIU admission. Patients transferred directly to a SCIU underwent earlier surgery (median (IQR) of 7.3 (6; 19) hours) than patients with indirect admission to SCIU, who waited 10 h longer to have their surgery (median (IQR) 17.5 (11; 31) hours). The study highlights specific areas for optimisation on a health system level and advocates improvement in early transport pathways to TSCI care to facilitate timely surgical treatment, leading to improved neurological outcomes and reduced secondary complications and mortality.

Practical Implications

Improved Triage Protocols

Implement stricter adherence to guidelines prioritizing direct SCIU transfer for patients injured within a 60-minute radius of a specialist unit.

Health Service Policy Adjustments

Motivate health service policy makers to investigate reasons for delayed transfers to SCIUs and consent to improvement strategies.

Resource Allocation

Justify the additional resource required to retrieve patients with acute TSCI aeromedically through comprehensive economic evaluation.

Study Limitations

1
The study was unable to include the complete cohort of patients with acute incident TSCI due to requirement of geographic variables, which introduces a possible selection bias.
2
Missing GIS data may be explained by the transition from paper to electronic NSW Ambulance data systems.
3
The study was limited in evaluation of the impact of regional ambulance services' different service and staffing capacity on transfer decisions.

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