Abstract
Background
In the Emergency Department cervical spine immobilisation precautions are frequently
used. There is controversy in regard to the balance of risks and benefits of routine
immobilisation in conscious patients.
Methods
A prospective multi-methods evaluation in a tertiary trauma referral centre. The objectives
were to investigate current practices and rate of concordance with established international
guidelines. A provider survey focused on current knowledge, skills and attitudes and
was disseminated to nurses, doctors and paramedics treating trauma patients. Additionally,
clinical data were collected on a cohort of immobilised trauma patients. Demographic
data were analysed using SPSS and content analysis was completed by manifest coding.
Results
The response rate to the survey was 85.2%. Interdisciplinary providers included nurses
(n=46), doctors (n=68) and paramedics (n=41).
Content analysis revealed a range of themes for improving care. Themes identified
included improved application of guidelines, tailored use of equipment in low-risk
patients, improved access to radiology results, and staff education. The series of
five case vignettes provided to participants revealed a high level of variance in
intended approaches to immobilisation. In the cohort of trauma patients (n=54), the median age was 54 years and the most common mechanism of injury was falls
(40.7%). Median time spent with immobilisation was 325min. Adherence to a recognised
decision tool was 35/54 (64.8%). Precautions were initiated by paramedics in 42/54
(77.8%).
Conclusions
Despite widespread dissemination of guidelines, observed approaches to patient immobilisation
appear to be highly variable in this trauma centre. Reducing variation for low-risk
patients is likely to improve the patient journey and minimise the risk of prolonged
immobilisation. Further assessment of the causes of variation could define goals for
targeted translational change.
Keywords
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Article info
Publication history
Published online: April 30, 2019
Accepted:
April 3,
2019
Received in revised form:
April 3,
2019
Received:
January 28,
2019
Identification
Copyright
© 2019 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
