4.2. Communication between Hubs and Spokes
The structural elements of the System of Care are linked by ongoing communication among providers to form an integrated network of care, meeting the needs of Veterans with SCI/D.
- Communication between providers at SCI Centers and non-SCI Center facilities must take place upon admission, clinical need, transfer, or discharge of any patient.
- The SCI Coordinator must notify the Chief, SCI Service, or designee, of admissions and discharges to non-SCI Center facilities using the SCD Registry's or Spinal Cord Injury and Disorders Outcomes (SCIDO) automated alert system or other appropriate mechanism.
- The Chief, SCI Service, or designee, must notify the SCI Coordinator of discharges from the SCI Center, using the SCD Registry's or SCIDO's automated alert system or other appropriate mechanism.
- Prompt communication between providers at SCI Centers and non-SCI Centers is vital to ensuring VA's ability to provide quality care to Veterans with SCI/D. Individual Veteran tracking and reporting by the SCI Coordinator, as Veterans enter and exit VA's medical and long-term care systems, is fundamental to the delivery of quality care and to ensuring that appropriate follow-up appointments are scheduled and provided in a timely manner.