1264 - Single center grading of SCI clinical practice guidelines.

The purpose of this project is to review the 13 currently available Paralyzed Veterans of America Clinical Practice Guidelines (CPG) for Spinal Cord Injuries to create a method in which to grade our institution on how closely our protocols align.


Design: The 13 available clinical practice guidelines were organized and independently reviewed by two researchers into 529 total recommendations. Recommendations were graded as either met, partially met and does not meet. Following an initial review, the guidelines were then reviewed by a multi-disciplinary SCI leadership team to discuss partially met and not meet recommendations and identify changes to make.

Results:

Off the 530 recommendations, our center met 66% (371), partially met 21% (112) and did not meet 13% (47). Of the 13 clinical practice guidelines, the categories that were most closely followed included Venous Thromboembolism (16 met, 1 partially met), Early Acute (68 met, 4 partially met, 1 Missed), and Outcomes (12 met 1 partially met). The categories where the most recommendations were missed included Mental Health (3 meet, 4 partially met), Sex (17 met, 32 partially met, 14 missed), and Cardiometabolic (14 met, 10 partially met, 3 missed). Of the 155 partially missed and missed recommendations, 111 were identified by working groups as  avenues for improvement within our institutions while the remaining 44 were identified as being either out of date with our current standard of care, represent services not feasible or covered by insurance, or represented small patient populations that is rarely managed by our hospital system.

Conclusions:

This project allowed our institution to consolidate, quantify and track the significant number of CPG recommendations available for deeper consideration and targeted process improvement. Next steps include reevaluation after process improvement, multicenter implementation using the same methodology to compare CPG adherence across institutions and providing feedback to CPG writers about adherence and practicality.