Reduced time on the spinal board—effects of guidelines and education for emergency department staff

• Published in: Injury Vol. 37; no. 1; pp. 53 - 56
• Main Authors: Yeung, Janice H.H., Cheung, N.K., Graham, Colin A., Rainer, Timothy H.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 2006; Elsevier
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Diseases of the osteoarticular system; Education, Continuing - methods; Emergencies; Emergency department; Emergency Medical Services - manpower; Emergency Medical Services - methods; Emergency Medical Services - standards; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Guidelines; Humans; Immobilization - instrumentation; Immobilization - methods; Injuries of the limb. Injuries of the spine; Medical sciences; Multiple Trauma - therapy; Orthopedic Equipment; Practice Guidelines as Topic; Spinal board; Spinal Cord Injuries - prevention & control; Spinal Injuries - prevention & control; Transportation of Patients - methods; Traumas. Diseases due to physical agents; Emergency department; Spinal board; Guidelines; Human; Health staff; Spine; Health care staff; Chi square test; Health education; Trauma; Recommendation; Time study; Board; Anesthesia; Recording; Public health; Nurse
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2005.05.002

Prehospital spinal immobilisation is usually accomplished with a spinal board. Prolonged immobilisation on spinal boards in the emergency department (ED) can be detrimental. This study aimed to reduce the time spent by patients on spinal boards using a staff education program. Observational study in a trauma centre ED seeing 180,000 ED attendances per year. The length of time immobilised on spinal board was recorded by the trauma nurse coordinator. Guidelines on removal of spinal boards were issued after recording period 1 (January–June 2001) and reinforced several times. The post-training period (period 2) extended from May to October 2003. Medians were compared using Mann–Whitney U-test (non-parametric data); chi-square test was used for categorical data. There were 122 eligible patients in period 1 and 104 eligible patients in period 2. Median time to removal from the spinal board was reduced by 18.5 min from 50 to 31.5 min (Mann–Whitney U-test, p < 0.0001, 95% CI for difference in medians 13–29 min). In period 1, 44 of 122 patients (36%) were removed from the spinal board before leaving the ED, compared to 78 of 104 patients (75%) in period 2 ( p < 0.0001, chi-square test). The introduction of guidelines, reinforced by ED staff education, can significantly reduce the time patients spend on spinal boards after trauma and can increase the proportion of patients who can be removed from the board before leaving the ED.