Study design Retrospective chart analyses as part of a quality improvement project. Objectives To demonstrate treatment of pressure injury (PI) in patients with spinal cord injuries (SCI) and analyse costs using the “modified Basel Decubitus Concept”. Setting Inpatient setting of a specialised acute care and rehabilitation clinic for SCI. Methods Complex treatment courses of four patients with chronic SCI and PI stage III or IV were described and costs were recorded. The total healthcare services’ costs per patient and different profession’s involvement were analysed in relation to patient characteristics, treatment phases and milestones demonstrated. Results The treatment of PI stage III and IV in patients with SCI included input from plastic surgery, rehabilitation medicine, nursing and other involved professions. Recommended interventions were chosen according to the “modified Basel Decubitus Concept”. The cost course of PI treatment in patients with SCI depicted the multimodal treatment concept, including three clinically and financially relevant milestones (debridement, flap surgery and mobilisation to wheelchair) as well as the highest costs in the functionally highly dependent patient. Acute care and rehabilitation overlapped with different intensities during the whole treatment process. Conclusion Multimodal treatment concepts connecting acute and rehabilitation care were applied in these complex health conditions. Cost-explication models including treatment phases and milestones helped to understand resources more easily and integrate aspects of process-based management and quality of care. Scientific evidence is needed to create a recommended quality standard in line with adequate financing of this health condition.
Background Stage III and IV pressure injuries (PIs) in patients with spinal cord injury (SCI) require complex interdisciplinary and interprofessional treatment approaches that are difficult to implement. Practical aspects, such as information exchange and coordination, remain challenging. We investigated whether a computerized decision support system (CDSS) could increase treatment adherence and improve clinical outcomes and interprofessional collaboration. Method In this feasibility study, a core team developed the initial treatment process and adapted it based on several discussions with clinical experts and information technologists. The CDSS followed the Basel Decubitus Approach and was used in a clinic specializing in SCI. Thirty patients with SCI admitted for stage III/IV PI between July 2016 and May 2017 were randomly allocated to standard or CDSS-supported care. Between-group differences in treatment adherence, complication rates, length of stay, and costs were analyzed using descriptive statistics. The use of the CDSS and potential barriers and facilitators were evaluated through interprofessional focus groups, transcribed verbatim, and thematically analyzed (30 participants). Results No differences in SCI characteristics, comorbidities, or PI characteristics (localization: ischium [number (n) = 19 PI, 63%], sacrum [n = 10 PI, 33%], recurrent PI [n = 21, 70%]) were found between the two groups. Furthermore, no statistically significant differences were observed in treatment adherence, frequency of major (20% vs. 13% between CDSS and control group) and minor (33% vs 27%) complications, and length of stay (98 [±28] vs 81 [±23] days). Healthcare professionals found the CDSS to be helpful for visualizing the treatment process. However, the high workload and difficulties in the information technology processes, such as missing reminders, slow computer performance and data processing, and poor accessibility, hindered the effective implementation of the CDSS. Conclusion The implementation of the CDSS to support the treatment of stage III/IV PI in patients with SCI was feasible and included definitions of milestones, interventions, and outcomes. However, to assess the impact of the CDSS, a longer observation period is required. Further, the technical difficulties must be addressed, and solid integration of the CDSS into the clinical information system is necessary. Trial Registration This quality improvement project received a declaration of no objection from the Ethics Committee of Northwest and Central Switzerland (EKNZ UBE-16/003), and ethical approval was received for the focus groups (EKNZ Req-2017-00860).
Background: Treatment of pressure injury (PI) stage III and IV in patients with spinal cord injury (SCI) requires complex interdisciplinary and inter-professional management described in comprehensive concepts. Although the implementation of these concepts in the clinical management is still difficult due to practical aspects as information and coordination challenges for example. The aim of this study was to develop, implement and test a computerized decision support system (CDSS) to increase concept adherence, improve inter-professional collaboration and optimize clinical outcome compared to usual care. Method: We implemented a CDSS picturing the Basel Decubitus Concept in an acute and rehabilitation clinic specialized for SCI as part of a quality improvement project in a real life two-group parallel design. We randomly allocated patients with SCI and PI stage III/IV for inpatient treatment to usual or CDSS supported care. We used an inclusive participatory development process, a qualitative focus group-based (30 participants) approach to capture the user perspective and prospective chart analyses to compare complication rates, length of stay and costs. Results: In both groups 15 patients were included showing no differences in SCI characteristics, comorbidities, and PI characteristics (localisation: ischium (19 PI, 63%), sacrum (10 PI, 33%), recurrent PI in 21 patients (70%)). Twenty-seven patients received surgical treatment (rotation flap in 12 patients (40%), posterior thigh flap in 15 patients (50%)). No statistically significant group differences were observed in the frequency of major (20% vs 13% between CDSS and control group) and minor (33% vs 27%) complications and length of stay (98 (±28) vs 81 (±23) days). The costs were similar. Although, health care professionals experienced the CDSS as helpful, high workload and difficulties in the information technology processes hindered its implementation.Conclusion: The introduction of a CDSS in the treatment of PI stage III/IV in patients with SCI was feasible, but technical and application problems limited its effectiveness. During the implementation and testing we learned that a clear definition of the whole treatment concept includes milestones, interventions and outcome definition. Technical requirements should include efficient reminder systems and clear visibility for all disciplines of the whole process. Trial registration: As a quality assurance study, this project holds a declaration of no objection by the Ethics Committee northwest/central Switzerland (EKNZ UBE-16/003) and received an ethical approval (EKNZ Req-2017-00860).
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