title: Reduced time on the spinal board-effects of guidelines and education for emergency department staff.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Observational study in a trauma centre ED seeing 180,000ED 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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Janice H H
authors.initials: JH
authors.lastname: Yeung
authors.forename: N K
authors.initials: NK
authors.lastname: Cheung
authors.forename: Colin A
authors.initials: CA
authors.lastname: Graham
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Rainer
mesh_terms: D004496:Education, Continuing / Q000379:methods; D004630:Emergencies; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D006801:Humans; D007103:Immobilization / Q000295:instrumentation* / Q000379:methods; D009104:Multiple Trauma / Q000628:therapy*; D009983:Orthopedic Equipment; D017410:Practice Guidelines as Topic; D013119:Spinal Cord Injuries / Q000517:prevention & control; D013124:Spinal Injuries / Q000517:prevention & control*; D014187:Transportation of Patients / Q000379:methods; D000078329:Workforce