The Development of a Certification and Grading Procedure for German SCI Units

Following World War II, spinal cord injury (SCI) care was established in Germany based on Guttmann’s philosophy of integrating post-SCI rehabilitation with acute treatment. A certification and grading process was established to protect existing centers. The German-Speaking Paraplegic Society (DMGP) developed a system that recognizes four levels of performance, ranging from 24/7 emergency coverage to rehabilitation-only services, to ensure qualified reimbursement negotiations. In 2019, the grading system was accepted, and most German SCI centers applied for certification based on a self-reported questionnaire. The development of the system was complex, with the aim of improving patient care.

• 1
  The grading system categorizes SCI units into four levels, from Level Ia (24/7 coverage for all SCI-related emergencies) to Level IIb (rehab only, no intensive care unit).
• 2
  The study found considerable variation in services and structures among SCI centers, necessitating the establishment of minimum standards and differentiation between surgical and conservative treatment units.
• 3
  A key finding was the necessity of differentiating between surgical units with and without available polytrauma treatment, as well as distinguishing units equipped with intensive care facilities.