Building and Sustaining Inpatient-Clinician Collaboration in Spinal Cord Injury Rehabilitation: A Case Example Using the Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC) and Goal Planning Programme

J. Clin. Med., 2022 · DOI: 10.3390/jcm11133730 · Published: June 28, 2022

Simple Explanation

Goal planning is essential for biopsychosocial rehabilitation, especially in spinal cord injury (SCI) settings. While theoretically grounded, its specific practices and impact lack universal standards. This paper discusses the standards at the National Spinal Injuries Centre (NSIC) since 1989 and the effects of quality improvement projects since 2016. The Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC) helps patients assess their needs upon admission and discharge, guiding tailored goal planning. Co-created by patients and clinicians, it has evolved through reviews and adaptations, including a version for children (SMS-NAC-ch). The program's success relies on collaborative goal setting involving patients, families, and multidisciplinary teams (MDT). Despite challenges in healthcare sustainability, systematic quality improvement methodologies can enhance goal planning in SCI rehabilitation, emphasizing the need for established standards.

Study Duration

Not specified

Participants

Adults and children and young people (CYP) with SCI

Evidence Level

Level Not specified, Case Example and International Survey

Key Findings

1
Inpatient attendance at goal planning meetings was generally high (near 100%), but family attendance varied, influenced by factors like the COVID-19 pandemic. MDT attendance collectively improved from 2016 to 2022, with physiotherapy, occupational therapy, and nursing showing notable increases.
2
Frequency of goal planning meetings showed an upward trend after amending the standard to within 4 weeks in 2018, aligning with NHS England Peer Review guidance. Completion of SMS-NAC within 2 weeks of mobilization showed variation, while SMS-NAC administration prior to discharge was impacted by reduced bed capacity.
3
The survey data reveals a lack of universal inclusion of inpatients in the adult and CYP goal planning meetings, and the reduction of inclusion between the adult surveys of 2018 and 2022 suggests a worrying trend.

Research Summary

This research highlights the importance of structured quality improvement methods in SCI rehabilitation, emphasizing the impact of setting practice standards for goal planning. The study found that consistent effort is required to maintain and improve quality, as macro-, meso-, and miso-level changes can easily lead to reductions in inpatient care. The survey results indicated a lack of universal inclusion of inpatients, raising concerns about the cornerstone of rehabilitation—developing self-care skills to live life well.

Practical Implications

Improved Goal Planning Standards

The findings call for establishing standard guidelines for goal planning practice in SCI rehabilitation, focusing on inpatient-clinician collaboration.

Enhanced Family Involvement

Efforts are needed to improve and sustain family involvement in goal planning meetings, considering factors such as technology access and patient preferences.

Consistent SMS-NAC Administration

There is a need to renew the focus on consistent administration of the SMS-NAC at discharge to ensure a safety net for identifying remaining skills and knowledge.

Study Limitations

1
The study did not record the details of the nominated family/significant other, impacting the understanding of family involvement.
2
Survey questions asked about intention rather than audited practice, which can yield differences in results.
3
Methodological limitations exist in the introduction, such as a common language regarding what is meant by goal planning, which may impact the conclusions from the survey.

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