North Queensland Spinal Cord Injury Service (NQSCIS)

Aim

Develop the capability and capacity to establish a specialist multidisciplinary spinal rehabilitation team based at Townsville University Hospital providing services to people within all five North Queensland HHS Delivers in-reach consultation, outpatient MDT clinics and home and community visiting.

Outcomes

• Centralised referrals with the QSCIS, data shows since inception have increased access to specialist spinal services for NQ patients by 160%
• Built workforce capability and recruited a comprehensive team of advanced and senior staff for medical, nursing and wide variety of allied health practitioners
• Improved diagnosis for low-level and cauda equina with data demonstrating this, have provided virtual and in-person shared care with the QSCIS and have saved more than 600 bed days in NQ hospitals through this
• Established an outpatient specialist clinic so people no longer have to travel to Brisbane
• Improved access to neurosurgical and pain medicine for people with SCI at TUH through relationship building.

Background

Equity issues relating to NQ patients include them not being able to have the same access to specialist spinal cord injury services as metropolitan areas. There are also long wait times to SIU at Princess Alexandra Hospital and poor knowledge translation of SCI rehabilitation resulted in decreased diagnosis and referral behaviours for NQ. There are high numbers of SCI patients in North Queensland with no services available close to home. The true demand for this service is not known.

Discussion

Significant collaboration and networking was required to support this. QSCIS provided significant BaSCI project time and in-kind contributions to assist with development of the NQSCIS.

Key learnings include that networked services and new specialist services require a growth transformation mindset so that existing workforce knowledge and resources can be leveraged for expansion and all participants are open about roles, responsibilities and expectations. Key findings also indicated that North Queensland had significantly more demand for SCI specialist rehabilitation than anticipated and that diagnosis, referral behaviours and consumer engagement were all previously negatively influenced by the distance and reduced visibility of the QSCIS being 1700+ km away. North Queenslander consumers also wanted a comprehensive embedded team including dietitian and indigenous liaison officer which differed from other Qld Health sites.

This project has resulted in a highly skilled new workforce in a regional area with over 130 active patients being provided services. It has enabled support to key clinicians in other North Queensland facilities to feel supported to continue to deliver high standards of care and enabled opportunity for growth and further recruitment of specialist who want to work in a specialist service. Feedback from broader services such as neurosurgical indicates this has also had positive impact on their workforce recruitment strategies by being able to highlight the importance of full continuum of care availability.

Significant improvement has been enabled for North Queensland people living with SCI to have a platform for improvement with their needs at the forefront of service design. The NQSCIS team has been able to have a paid SCI consumer on their advisory committee and has transitioned a highly passionate SCI consumer into paid employment due to their significant lived experience knowledge.

References

Cheng CL, Plashkes T, Shen T, Fallah N, Humphreys S, O'Connell C, Linassi AG, Ho C, Short C,

Ethans K, Charbonneau R, Paquet J, Noonan VK. (2017). Does Specialized Inpatient Rehabilitation Affect Whether or Not People with Traumatic Spinal Cord Injury Return Home? Journal of Neurotrauma. Oct 15;34(20): 2867-2876. doi: 10.1089/neu.2016.4930. Epub 2017 May 24. PMID: 28447870.

Goodwin-Wilson, C., Watkins, M. & Gardner-Elahi, C. (2010). Developing evidence-based process maps for spinal cord injury rehabilitation. 'Spinal Cord'48, 122-127. https://doi.org/10.1038/sc.2009.94

McKechnie, D., Pryor, J., Fisher, M. J., & Alexander, T. (2019). A comparison of patients managed in specialist versus non-specialist inpatient rehabilitation units in Australia. ¯Disability and Rehabilitation, 42(19), 2718 -2725. https://doi.org/10.1080/09638288.2019.1568592

System Planning Branch. (September 2024) Spinal Cord Injury Service Delivery Model for Queensland:

Co-design Process and Outcomes Report. Queensland Health. https://www.health.qld.gov.au/__data/assets/pdf_file/0030/1364592/Spinal-Cord-Injury-Service- Delivery-Model-for-Queensland-Outcomes-Report_Digital.pdf

System Planning Branch. (December 2024). Spinal Cord Injury Service Delivery Model for Queensland.

Queensland Health. https://www.health.qld.gov.au/__data/assets/pdf_file/0029/1364591/Spinal-Cord-Injury-Service Delivery-Model-for-Queensland_Digital.pdf