Working towards a unified evaluation process for complex nerve injuries

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Since 2011 British Columbians with major nerve injuries come to the British Columbia Centre for Complex Nerve Injury (BCCNI) at VGH for care. Previously patients were referred first to an electromyography lab for nerve testing, after which they were sent to a surgeon and then waited for surgery. If they didn’t do well, they could wait further to see a physiatrist. Depending on where the patient lived, they may have had to fly to and from Vancouver several times.

“We completely shifted that model to a one-stop-shop, value-based health-care model where patients see the whole team in a wraparound fashion,” said Dr. Kristine Chapman, BCCNI co-lead. “They see the surgeons, the neurologist, and the rehab doctors all together. Then we make a plan—whether it’s surgical or non-surgical—and we follow the patients over the whole course of their treatment, which can be two or more years, while the nerve repairs.”

The new model includes doctors as well as technologists and is hoping to soon integrate allied health staff. It’s a complex multidisciplinary team. The challenge is that these professionals do not all evaluate patients the same way. That’s where VPSA’s project funding was able to help.

“We were able to use Engagement Accelerator funding to optimize our teamwork and strive to find the best way to evaluate patients and then make sure we’re doing this in a consistent way,” said Dr. Chapman.

“We have the biggest group of physicians that I’m aware of in North America who are doing this in a one-stop-shop fashion,” said BCCNI co-lead Dr. Sean Bristol. “We’re a big group and we’ve got lots of different opinions. We needed something that would formalize what we thought was an acceptable outcome measure and then take that and generate research that can be applied universally and understandable to other groups across the world.”

VPSA’s funding paid for physician time spent in workshops to determine goals and objectives, review best outcomes, and help define what scale to use for patient evaluation.

“The funding enabled us to take time as a group to come together and decide what was important for patients,” said Dr. Chapman. “I don’t think we would have been able to step out of our busy clinic setting without this grant.”

“The funding gave us the opportunity to do more than just talk about our need for consistent evaluation. It brought us together and helped us recognize that we are a team with a goal of determining how to make the process work as opposed to eight or nine individuals,” said Dr. Bristol. “We now function much more as a team for our patients.”

Once the clinic determines what scale it will use, the next step will be to scale up the model and share it with other nerve injury programs across Canada. The data collected is being adapted into a research project that will be published and shared nationally.

“The changes in our field are unbelievable,” said Dr. Chapman. “Previously there were very few treatment options. Now, with nerve transfers and other surgical advances, it’s a whole new playing field for patients. This combined with an understanding of brain plasticity and nerve rehabilitations have transformed outcomes for people with devastating nerve injuries.”

“We’re definitely a North American leader in the treatment of complex nerve injuries,” agreed Dr. Bristol. “We are generating meaningful research, showing our outcomes, and showing how our model works. It’s an exciting time.”

Do you have a project that could use funding? Check out VPSA’s Small Steps, Big Idea initiative. Proposals are reviewed as they are received, and funding is awarded on an ongoing basis.

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