Canadian emergency departments (EDs) annually treat 1.3 million patients who have suffered blunt trauma from falls or motor vehicle collisions and who are at risk for cervical spine (c-spine) injury. Most such cases are alert and stable adults. Less than 1% has a c-spine fracture. A majority of trauma victims transported in ambulances are protected by a backboard, collar, and sandbags and, on arrival at the ED, are sent to high acuity resuscitation rooms, where they remain fully immobilized for hours until physician assessment and x-rays are complete. [i] This prolonged immobilization is often unnecessary and adds considerably to patient discomfort and to the burden on our overcrowded Canadian EDs in an era when they are under unprecedented pressures.
The Canadian C-Spine Rule (CCR) is a clinical decision rule that allows clinicians to “clear” the cervical spine without the need for an x-ray and to decrease immobilization times. This rule has been widely adopted by ED physicians and has recently completed testing for accuracy, reliability and safety amongst ED triage nurses. This project will optimize resources through the use of inter-professional teams, allowing for specially trained nurses to assess patients using the Canadian C-Spine Rule.
The CCR was successfully implemented across eight hospitals. It demonstrated a 26% reduction in ED wait times for applicable adult trauma patients, and it increased efficiencies by maximizing the use of education resources and by ensuring collaboration between nursing and physicians.
The following hospitals participated in the CAHO Canadian C-Spine Rule ARTIC Project: Kingston General Hospital, London Health Sciences Centre, Hôpital Montfort, North York General Hospital, St. Michael’s Hospital, Health Sciences North, Sunnybrook Health Sciences Centre, Thunder Bay Regional Health Sciences Centre and University Health Network.