Implementation of clinical quality management including standardized reporting and individualized management during first rehabilitation of patients with spinal cord

• Published in: Annals of physical and rehabilitation medicine 2018-07, Vol.61, p.e546-e547
• Main Authors: Scheel-Sailer, A., Bersch, I., Pannek, J., Schmitt, K., Schneider, J., Sigrist-Nix, D., Baumberger, M.
• Format: Article
• Language: English
• Subjects: Assessment; Quality management; Spinal cord injury
• ISSN: 1877-0657; 1877-0665
• DOI: 10.1016/j.rehab.2018.05.1272

Clinical quality management (QM) during acute and post-acute rehabilitation after newly acquired spinal cord injury (SCI) remains challenging due to complex impaired functioning including bio-psycho-social aspects. International societies developed recommendation for standardized reporting with respect to the international classification of functioning (ICF). However, there is still a lack of implementation of these recommendations. Therefore, this study aims to analyze reasons and create strategies to implement these guidelines in daily practice. Situation analyses, consensus process and requirement analyses of clinical QM in a specialized SCI rehabilitation centre. SCI specific and validated assessments were applied consequently after newly acquired SCI when a controlling system existed (e.g., Spinal Cord Injury independence Measure III: SCIM III) and partly with recommendation (e.g., International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI)). The individual management appeared complex and could not be easily reported in a standardized and comparable way. The leadership decided to use a consensus process to develop an assessment standard according to national and international requirements (Common Data Elements, EMSCI, SwiSCI, ICF Core Sets, association of national quality (ANQ)). For data and process based management the information technology (IT) had to fulfil different requirements (reminder system, clear visibility, connectivity of information). Education tools in specific health professional groups concerning the goal-orientated use of assessments were needed to increase knowledge and to use the assessments. Improvement in patient-centred communication and interdisciplinary team culture optimized the individualized rehabilitation management. Implementation of QM during acute and post-acute care after SCI succeeds when respecting national and international standards, when clinical IT systems are integrated in the decision making, when health professionals are aware of patient-centred communication and continuous education covering these aspects takes place. Change management may happen when representatives of all intended groups are engaged and adequate resources available.