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International Journal for Quality in Health Care Advance Access originally published online on September 20, 2007
International Journal for Quality in Health Care 2007 19(6):377-381; doi:10.1093/intqhc/mzm043
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© The Author 2007. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved

Metastatic spinal cord compression as an oncology emergency—getting our act together

Khai Lee1, Ian Tsou2, Seng Wong3, Chun Yu4, Zhu Ming5, Yuen Loh1, Thomas Shakespeare1, Rahul Mukherjee1 and Michael Back1

1 Department of Radiation Oncology, The Cancer Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore
2 Department of Diagnostic Imaging, Tan Tock Seng Hospital, Singapore, Republic of Singapore
3 Department of Medical Oncology, The Cancer Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore
4 Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
5 Clinical Trials and Epidemiology Research Unit, Singapore

Background. Metastatic spinal cord compression is a dreaded complication of cancer affecting 5–10% of patients requiring urgent treatment. A clinical practice improvement project was carried out to review and fine tune the clinical pathway for the acute management of patients with metastatic spinal cord compression.

Objective. To improve the quality of care for metastatic spinal cord compression over 6 months by ensuring that >90% of patients receive definitive treatment within 24 h of radiological diagnosis.

Method. Using clinical practice improvement project methodology, the clinical pathway of 17 patients treated with radiotherapy for metastatic spinal cord compression within the last 6 months were reviewed to identify gaps and delays in the system. Interventions to form a multidisciplinary acute spinal cord crisis team, fine tune clinical referral processes and formulate a standardized treatment protocol were then implemented. Post-intervention of 22 subsequent patients were monitored for time to start steroids and radiation therapy, length of stay and hospitalization bill.

Results. With the interventions implemented, the mean response time to start steroidal therapy was reduced from 8.4 to 2.6 days and radiotherapy from 9.9 to 3.9 days. These translated into shorter mean length of stay from 23.8 to 14.7 days and smaller hospitalization bill size from Singapore$13 723 to 8808.

Conclusion. A clinical practice improvement project, to improve the quality of care for patients with metastatic spinal cord compression, can shorten response time to start steroidal therapy and definitive radiotherapy resulting in shorter length of stay and smaller hospitalization bill.

Keywords: clinical pathway, metastatic spinal cord compression, multidisciplinary, radiotherapy, steroids

Address reprint request to Khai Mun Lee, Department of Radiation Oncology, The Cancer Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Republic of Singapore. E-mail: khai_mun_lee{at}ttsh.com.sg

Accepted for publication August 17, 2007.


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