title: Improving care standards for patients with spinal trauma combining a modified e-Delphi process and stakeholder interviews: a study protocol.
abstract: Around 300 people sustain a new traumatic spinal cord injury (TSCI) in Australia each year; a relatively low incidence injury with extremely high long-term associated costs. Care standards are inconsistent nationally, lacking in consensus across important components of care such as prehospital spinal immobilisation, timing of surgery and timeliness of transfer to specialist services. This study aims to develop 'expertly defined' and agreed standards of care across the majority of disciplines involved for these patients.
  
  
  
  A modified e-Delphi process will be used to gain consensus for best practice across specific clinical early care areas for the patient with TSCI; invited participants will include clinicians across Australia with relevant and significant expertise. A rapid literature review will identify available evidence, including any current guidelines from 2005 to 2015. Level and strength of evidence identified, including areas of contention, will be used to formulate the first round survey questions and statements. Participants will undertake 2-3 online survey rounds, responding anonymously to questionnaires regarding care practices and indicating their agreement or otherwise with practice standard statements. Relevant key stakeholders, including patients, will also be interviewed face to face.
  
  
  
  Ethics approval for this study was obtained by the NSW Population & Health Services Research Ethics Committee on 14 January 2016 (HREC/12/CIPHS/74). Seeking comprehensive understanding of how the variation in early care pathways and treatment can be addressed to achieve optimal patient outcomes and economic costs; the overall aim is the agreement to a consistent approach to the triage, treatment, transport and definitive care of acute TSCI victims. The agreed practice standards of care will inform the development of a Clinical Pathway with practice change strategies for implementation. These standards will offer a benchmark for state-wide and potentially national policy.
authors.affiliation: Sydney Medical School Northern, The University of Sydney, Sydney, New South Wales, Australia.|John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia.
authors.forename: Lisa N
authors.identifier: 0000-0001-8977-6144
authors.initials: LN
authors.lastname: Sharwood
authors.affiliation: Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Ralph
authors.initials: R
authors.lastname: Stanford
authors.affiliation: Sydney Medical School Northern, The University of Sydney, Sydney, New South Wales, Australia.|John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia.|State Spinal Cord Injury Service, NSW Agency for Clinical Innovation, Sydney, New South Wales, Australia.
authors.forename: James W
authors.initials: JW
authors.lastname: Middleton
authors.affiliation: Sydney Medical School Northern, The University of Sydney, Sydney, New South Wales, Australia.|Greater Sydney Area Helicopter Emergency Medical Service, Sydney, New South Wales, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Burns
authors.affiliation: Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Joseph
authors.affiliation: Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Oliver
authors.initials: O
authors.lastname: Flower
authors.affiliation: John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia.|Greater Sydney Area Helicopter Emergency Medical Service, Sydney, New South Wales, Australia.|Institute for Trauma and Injury Management, NSW Agency for Clinical Innovation, Sydney, New South Wales, Australia.
authors.forename: Oran
authors.initials: O
authors.lastname: Rigby
authors.affiliation: John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia.|Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Ball
authors.affiliation: John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia.
authors.forename: Shelly
authors.initials: S
authors.lastname: Dhaliwal
mesh_terms: D001315:Australia; D032921:Consensus; D019091:Critical Pathways / Q000592:standards; D003697:Delphi Technique; D006801:Humans; D016134:Organizational Policy; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D013119:Spinal Cord Injuries / Q000628:therapy*; D059039:Standard of Care
keywords: EPIDEMIOLOGY; HEALTH ECONOMICS