A Multicenter Program to Implement the Canadian C-Spine Rule by Emergency Department Triage Nurses - 19/09/18
, Catherine M. Clement, RN b, Maureen Lowe, RN b, Connor Sheehan, BA b, Jacqueline Miller, RN, MSc d, Sherry Armstrong, RN, BScN g, Brenda Bailey, RN, BScN e, Kerry Posselwhite, RN, BScN f, Jannick Langlais, RN, BScN h, Karin Ruddy, RN, BScN i, Susan Thorne, RN, BScN j, Alison Armstrong, RN, BScN k, Catherine Dain, RN, APN c, Jeffrey J. Perry, MD, MSc a, b, Christian Vaillancourt, MD, MSc a, bAbstract |
Study objective |
The Canadian C-Spine Rule has been widely applied by emergency physicians to safely reduce use of cervical spine imaging. Our objective is to evaluate the clinical effect and safety of real-time Canadian C-Spine Rule implementation by emergency department (ED) triage nurses to remove cervical spine immobilization.
Methods |
We conducted this multicenter, 2-phase, prospective cohort program at 9 hospital EDs and included alert trauma patients presenting with neck pain or with cervical spine immobilization. During phase 1, ED nurses were trained and then had to demonstrate competence before being certified. During phase 2, certified nurses were empowered by a medical directive to “clear” the cervical spine of patients, allowing them to remove cervical spine immobilization and to triage to a less acute area. The primary outcomes were clinical effect (cervical spine clearance by nurses) and safety (missed clinically important cervical spine injuries).
Results |
In phase 1, 312 nurses evaluated 3,098 patients. In phase 2, 180 certified nurses enrolled 1,408 patients (mean age 43.1 years, women 52.3%, collision 56.5%, and cervical spine injury 1.1%). In phase 2 and for the 806 immobilized ambulance patients, the primary outcome of immobilization removal by nurses was 41.1% compared with 0% before the program. The primary safety outcome of cervical spine injuries missed by nurses was 0. Time to discharge was reduced by 26.0% (3.4 versus 4.6 hours) for patients who had immobilization removed. In only 1.3% of cases did nurses indicate their discomfort with applying the Canadian C-Spine Rule.
Conclusion |
We clearly demonstrated that ED triage nurses can successfully implement the Canadian C-Spine Rule, leading to more rapid and comfortable management of patients without any threat to patient safety. Widespread adoption of this approach should improve care and comfort for trauma patients, and could decrease length of stay in our very crowded EDs.
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| Please see page 334 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD |
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| Author contributions: IGS conceived the idea and secured research funding. CMC and ML coordinated the study. JM, SA, BB, KP, JL, KR, ST, AA, and CD supervised the recruitment of patients and management of data. All authors supervised the conduct of the trial and data collection, and drafted the article, contributed to its revision, and approved the final version. IGS takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. This study was funded by a peer-reviewed grant from the Council of Academic Hospitals of Ontario. |
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Vol 72 - N° 4
P. 333-341 - octobre 2018 Retour au numéro
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