Diffusion of medical progress: early spinal immobilization in the emergency department

To examine the spread of new techniques of spinal care through one state's emergency departments (EDs).

This was a telephone survey of all 36 EDs in a single state. One physician from each ED was contacted and given a short structured survey instrument to determine when patients who arrived at the ED on backboards were removed from the backboards. Removal was classified as "immediate" if it was done before clinical or radiographic exclusion of cervical spine injury and "delayed" if it was done only after interpretation of any indicated diagnostic radiologic procedures. Further questions were asked to determine if all physicians in the group used the same technique and how this technique had been adopted.

In all but four hospitals, patients were removed from backboards in the same manner by all physicians, using a protocol or standard procedure. Fifteen of these did immediate and seventeen did delayed removal. In all but one case, the approach of immediate removal was initiated at the hospital by a physician trained or recently working at a university facility. Eight respondents stated that transport service requirements influenced their decision.

Although logic and the medical literature support removing all patients from a backboard immediately, physicians were unlikely to change their practice after their formal training had been completed until a new member of their group had done so.