Good Practice

Management of Individuals with Spinal Cord Injury in General Hospitals – Good Practice Guide.
British Association of Spinal Cord Injury Specialists

A Report of the British Association of Spinal Cord Injuries Specialists.
Compiled, in 2003, by:

Late Mr G Ravichandran FRCS
Consultant in Spinal Injuries
Princess Royal Spinal Injuries Unit, Sheffield

Professor W S El Masri
Consultant Surgeon in Spinal Injuries FRCS Ed
Professor in Spinal Injuries, University Of Keele
Chairman  British Association of Spinal Cord Injury Specialists (1999 – 2006)
RJ & AH Orthopaedic Hospital

(This guideline is currently being updated)

Executive Summary

Survival of individuals with spinal cord injury has progressively improved as a result of advances in the acute and long term management of the paralysed.  Similar improvements in the care of poly-traumatised patients have resulted in the survival of paralysed patients with multiple other injuries/diseases.

Both the long-term survivors and individuals with acute traumatic spinal cord injury are inevitably referred to local District General Hospitals [DGH] where primary care is given. Changing patterns of healthcare delivery, increasing public expectation, and the implementation of Clinical Governance have resulted in a significant escalation of litigations against General Hospitals by people with spinal cord injury.  Many of these litigation’s are settled out of court and do not usually attract the attention of the general public.

Specialist centres dealing exclusively with patients with spinal cord injury have been aware for sometime that in certain instances the application of simple and basic techniques in the management of paralysed patients would substantially improve the quality of care received by the paralysed in DGHs.

The British Association of Spinal Cord Injury Specialists [BASCIS] believes that failure to prevent avoidable complications in patients with spinal cord injury is the cause of increased morbidity and a significant increase in the total time spent in  hospital.  This Good Practice Guide is intended to improve healthcare given to people with spinal cord in non- specialist centres.

The key objectives of Clinical Governance are:

  1. To provide reassurance to patients, managers and clinical staff alike that
    • Quality of care drives decision making about provisions of services within each Trust
    • Care delivered within each service meets the required standards
    • Planning and delivery of services take full account of the prospective of patients
  2. To support clinical staff in improving quality of care
  3. To ensure that poor performance is identified and dealt with.
  4. To help DGHs minimise litigation