A pilot of the ACI’s Spinal Cord Injury Model of Care at three NSW hospitals is giving more clinicians and patients access to advice and support from specialist services.
The pilot was launched in March by the ACI State Spinal Cord Injury Service (SSCIS) to test a networked hub and spoke model that connects local services with specialist teams. The model aims to improve patient access and build spinal cord injury (SCI) care capacity and capability across the NSW health system.
A spinal cord injury is a life‑changing condition that often requires lengthy hospital stays and specialised, multidisciplinary care. Evidence shows that many people in NSW with a serious spinal injury do not receive care at Sydney’s specialist SCI units, which include Royal North Shore Hospital, Prince of Wales Hospital and Royal Rehab, explains Professor James Middleton. James is the SSCIS Clinical Director, Professor of Rehabilitation Medicine at University of Sydney, Staff Specialist at Royal Rehab and President of the International Spinal Cord Society.
With limited specialist services and increasingly complex presentations, we need innovative ways to manage resources effectively and provide coordinated, multidisciplinary care.
For people who receive care in non-specialist hospitals, two-thirds could benefit from access to specialist care. Likewise, less complex patients managed in specialist SCI units could benefit from receiving care at hospitals closer to home. Longer lifespans and ageing patients with complex care needs are also increasing service demand.
The ACI pilot implementation aims to ensure specialist unit beds are available for managing the most complex cases, while providing specialist-guided multidisciplinary SCI care to patients in non-specialist settings.
Piloting pathways to best-practice care
Clear clinical pathways established for the pilot provide access to the expertise and experience available at hub sites Royal North Shore Hospital and Royal Rehab. The multidisciplinary expertise they provide to the spoke site at John Hunter Hospital also enhances local workforce capability for its nursing, medical and allied health staff.
The pilot includes a central notification system that identifies all new SCI cases and triages patients via 4 pathways:
- Complex patients receive expert care at Royal North Shore Hospital and Royal Rehab (pilot specialist hub sites).
- Complex patients are transferred from John Hunter Hospital (pilot non-specialist spoke site) to the hub sites.
- Patients stay at John Hunter Hospital and receive multidisciplinary expertise from the hub site via virtual care, and tailored, onsite specialist support.
- Patients at John Hunter Hospital receive care without hub input.
For example, in practice this could mean that a patient receives initial urgent care for an SCI at John Hunter Hospital, is identified through the central notification system, triaged as suitable for specialist spinal care (pathway 2) and transferred to Royal North Shore Hospital. They then might return to John Hunter for rehabilitation closer to home (pathway 3).
These pathways and the formalised hub and spoke network, alongside mentoring, education and training, have replaced ad-hoc advice and informal networks. This enhances communication and coordination between sites and can help improve staff job satisfaction. As part of the pilot, the ACI is also supporting clinician capability building and better integration of lived experience to enhance the confidence and ability of people with SCI to access support after discharge.
Building trust leads to early success
Since launch, 45 patients have been treated under the pilot model, and 118 clinicians have completed capability-building sessions.
With triage pathways being consistently applied, clinicians report greater clarity, improved communication and less reliance on informal networks and workarounds.
The project has brought many benefits, and our communication with Royal North Shore Hospital has improved greatly.
“Building trust and minimising clinical burden has helped us secure executive and clinical support for the pilot and lead to these early successes,” explains Komal Adarkar, the SSCIS Network Manager, who is leading the project for the ACI.
While the pilot is in its early stages, several key insights have emerged:
- Clear pathways improve care and reduce unwarranted clinical variation.
- Specialist input strengthens capability and supports care closer to home.
- Central coordination improves timely access to care and expertise.
With the pilot ongoing until June 2027, the ACI is continuing to strengthen triage pathways, shared care planning, clinician capability, consumer confidence and access to community support. Learnings from the pilot and an evaluation will inform next steps for planning and scaling the model across the state.
Related resources
- Learn more about the Spinal Cord Injury Model of Care
- Access the report into the evidence and utilisation of spinal cord injury services in NSW
- Stay informed on healthcare innovation by subscribing to Clinician Connect