Improving the Quality of Care for Children with Spinal Cord Injuries
Poster #: 008
Session/Time: A
Author:
Khushie Matharoo, BS
Mentor:
Kyrie Shomaker, MD
Research Type: Clinical Medicine and Quality Improvement
Abstract
INTRODUCTION:
Patients with spinal cord injury (SCI) exhibit a wide range of bodily dysfunction post-injury leading to secondary health conditions including para/quadriplegia, pressure ulcer, autonomic dysreflexia, venous thromboembolism, mental health issues, and bladder dysfunction. Specific to the genitourinary system, SCI commonly leads to urinary retention, which predisposes patients to urinary tract infection and upper urinary tract/renal injury. Therefore, timely consultation with multidisciplinary specialists is essential in achieving the best outcomes in patients with SCI. Our objective is to evaluate urological care for patients with SCI with bladder dysfunction, examine possible reasons for delayed urology consultation, and conduct a Plan-Do-Study-Act (PDSA) cycle to affect the specific aim of timely urology consult for this patient population within 48 hours of inpatient rehabilitation admission.
METHODS:
A cohort of 44 patients with SCI admitted to CHKD inpatient rehabilitation between 2020-2025 was analyzed to identify patterns in acute admission, timing of consultation, rehab stay, and urinary outcomes for the subset of patients with bladder dysfunction. An Ichikawa diagram and process chart were used to identify potential causes of delay in consultation. Pareto charts were used to stratify and target variables significantly contributing to negative urinary outcomes.
RESULTS:
Sixty-six percent of patients with SCI (n=29) had bladder dysfunction. Outcome measures included proportion of patients with urinary complications out of all patients with bladder dysfunction (58%, 17/29) and proportion of those with ≥ 1 urinary complication (17%, 3/17). Process measures included rate of urology consultation in patients with bladder dysfunction (31%, 9/29) and timeliness of consult within 48 hours of rehab admission (55%, 5/9). Process mapping and fishbone diagramming revealed that early urologic consultation is highly dependent on single individuals on the inpatient rehabilitation and urologic teams.
CONCLUSION:
Key drivers of reduced negative urologic outcomes include facility/service line serving patient during acute injury admission and presence or absence of early urologic consultation. Other identified drivers were mechanism/level of injury, nursing procedures implemented during IPR, and presence or absence of an order set to systematize urologic consultation and implementation of an appropriate bladder protocol. PDSA cycles are currently underway to increase the proportion of patients with SCI-related bladder dysfunction with early urologic consultation. This project provides a framework for an informed and structured way to enact change in the inpatient rehabilitation unit to help decrease negative urologic outcomes in pediatric patients with SCI.
Patients with spinal cord injury (SCI) exhibit a wide range of bodily dysfunction post-injury leading to secondary health conditions including para/quadriplegia, pressure ulcer, autonomic dysreflexia, venous thromboembolism, mental health issues, and bladder dysfunction. Specific to the genitourinary system, SCI commonly leads to urinary retention, which predisposes patients to urinary tract infection and upper urinary tract/renal injury. Therefore, timely consultation with multidisciplinary specialists is essential in achieving the best outcomes in patients with SCI. Our objective is to evaluate urological care for patients with SCI with bladder dysfunction, examine possible reasons for delayed urology consultation, and conduct a Plan-Do-Study-Act (PDSA) cycle to affect the specific aim of timely urology consult for this patient population within 48 hours of inpatient rehabilitation admission.
METHODS:
A cohort of 44 patients with SCI admitted to CHKD inpatient rehabilitation between 2020-2025 was analyzed to identify patterns in acute admission, timing of consultation, rehab stay, and urinary outcomes for the subset of patients with bladder dysfunction. An Ichikawa diagram and process chart were used to identify potential causes of delay in consultation. Pareto charts were used to stratify and target variables significantly contributing to negative urinary outcomes.
RESULTS:
Sixty-six percent of patients with SCI (n=29) had bladder dysfunction. Outcome measures included proportion of patients with urinary complications out of all patients with bladder dysfunction (58%, 17/29) and proportion of those with ≥ 1 urinary complication (17%, 3/17). Process measures included rate of urology consultation in patients with bladder dysfunction (31%, 9/29) and timeliness of consult within 48 hours of rehab admission (55%, 5/9). Process mapping and fishbone diagramming revealed that early urologic consultation is highly dependent on single individuals on the inpatient rehabilitation and urologic teams.
CONCLUSION:
Key drivers of reduced negative urologic outcomes include facility/service line serving patient during acute injury admission and presence or absence of early urologic consultation. Other identified drivers were mechanism/level of injury, nursing procedures implemented during IPR, and presence or absence of an order set to systematize urologic consultation and implementation of an appropriate bladder protocol. PDSA cycles are currently underway to increase the proportion of patients with SCI-related bladder dysfunction with early urologic consultation. This project provides a framework for an informed and structured way to enact change in the inpatient rehabilitation unit to help decrease negative urologic outcomes in pediatric patients with SCI.