CIHR Team in Safety Culture for Spinal Manipulation Therapy: (SAFETY NET: an academic and professional partnership building a culture of safety for Spinal Manipulation Therapy)
Principal Investigators: Drs. Sunita Vohra; Heather S. Boon; Timothy A. Caulfield; Gregory N. Kawchuk; Maeve O'Beirne
University of Alberta
Many Canadians are turning to complementary therapies to meet their health needs. The most popular complementary practice in North America is Spinal Manipulation Therapy (SMT), a regulated treatment that is commonly provided by chiropractors. Back and neck pain often lead people to seek SMT, and recent estimates suggest that as many as 50% of Canadians have received SMT at least once in their lives.
Despite the growing popularity of SMT, as in primary care, no formal mechanism currently exists to track reports of injury or harm. “Patients may report adverse events directly to a regulatory college, and health care providers may also communicate with their respective college or insurance company,” explains Dr. Sunita Vohra, Director of the Integrative Health Institute at the University of Alberta and leader of SAFETY NET: an academic and professional partnership building a culture of safety for SMT. “However, there is no mechanism to systematically collect this data in a manner to learn from the events.”
The adverse events associated with SMT can range from mild (something that resolves on its own, such as muscle soreness) to serious (something that requires medical attention, such as a fractured rib). Although chiropractors are the most recognized SMT provider, it can also be delivered by physicians, osteopaths, and physical therapists—which means that there are a lot of practitioners across Canada—so the SAFETY NET team decided to work with these groups to identify reporting strategies that would work in their practices, including the design of appropriate forms that practitioners and patients can use to report any type of adverse event associated with SMT. The team is using these forms to conduct active surveillance in the community offices of participating practitioners across Alberta in order to identify adverse events and to investigate the mechanism of injury underlying the event, which could ultimately contribute to injury prevention.
“Health care can have unintended effects,” says Dr. Vohra. “Only by observing, measuring, reporting, and analyzing adverse events can we learn from them. Our intent is to identify and prevent adverse events whenever possible, and to identify risk factors to help make care safer.”
The SAFETY NET team has actively engaged a diverse group of SMT professional associations, educational bodies, and policy makers in their work, and the relationships that they have developed with the community and their partners have been very positive. Patient safety is a top priority for practitioners, and many welcome the opportunity to learn from each other about excellent care.
“We are very pleased to participate in the SafetyNET projects,” says Dr. Anthony Tibbles, the Associate Dean, Clinics, at the Canadian Memorial Chiropractic College. “Our participation has enabled us to inform our community of the importance of a culture of safety within our clinic system. It has also provided a unique opportunity to not only benchmark but also introduce strategies to improve related safety aspects of our care delivery.”
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