Operationalizing an early time-to-decompression best practice & monitoring approach in a provincial health system.

A collaborative, multidisciplinary, provincial approach was constructed involving a provincial working group (WG) in a province-wide health system in Alberta, Canada to advance an early (< 24 h) time-to-decompression for adult patients with traumatic spinal cord injury (traumatic SCI). Key elements for the WG included the organizational context; theoretical foundation and guiding principles; pre-engagement activities; WG activities; and evidence reviews. This approach yielded inter-connected deliverables to advance early time-to-decompression in traumatic SCI: (1) a provincial best practice recommendation for Alberta's health system; (2) a near-real-time (weekly) provincial dashboard using a Large Language Model; and (3) a committed, local and provincial monitoring and learning approach. This work exposed early challenges to realizing and monitoring early spinal decompression for acute traumatic SCI in Alberta, and the opportunity to use artificial intelligence to capture near-real-time data for provincial improvement and learning at system-level. Balancing information in the dashboard led to noise in that data, which suits monitoring versus accountability framework. Merging community, learning and AI enabled multidisciplinary interest-holders in acute traumatic SCI to advance towards timely access to surgical decompression.Sponsorship: PRAXIS Spinal Cord Institute, Acute Care Alberta, Alberta Health Services.