Download 4.3 NTS 2014 Paula DiMarco Sharon Smith (2)

Transforming Trauma
Rehabilitation
Recommendations for the North East
Region
Sharon Smith
Paula Dimarco
1 NHS | Presentation to [XXXX Company] | [Type Date]
Overview of talk
•
•
•
•
•
Purpose of project
Background of project
Best practice pathway
Key findings
Recommendations
Purpose of project
•
On behalf of NE SHA
•
•
•
Provide information and recommendations
Develop a best practice pathway
Support commissioning for development of rehabilitation
services following major or serious trauma
The Project
•
•
•
Regional steering group
Two work streams, JCUH and RVI
Review of MSK and neurological rehabilitation
•
•
•
•
Map of current pathway
Data collection and analysis
Stakeholder consultations
Identify models of best practice
•
Gap analysis
Best practice pathway
Key findings
No consultants in Rehabilitation Medicine
in MSK and insufficient within neurotrauma
National Standards Recommend:
• 6 WTE per million population
• No single handed consultants
Current Regional Provision:
• 3.8 WTE in level 1 Services
• 3 WTE in level 2 services all working single
handed
There is a 2/3 Shortfall on the national standards.
Lack of communication, co-ordination and
leadership across the pathway leading to
disjointed care and inadequate
management of patients
• RVI has head injury nurse specialist
• JCUH has acquired brain injury coordinator
• No formal coordinated MDT rehab specifically for
TBI at either MTC
• No coordinator for MSK at either MTC
• Rehabilitation needs to be well planned across
the whole pathway, including TUs and community
services
No specialist inpatient beds for MSK
rehabilitation resulting in longer lengths of
stay in acute beds or transfer to
inappropriate settings
• Case example:
• 55 year old male – MSK polytrauma including ITU
stay
• MTC also patient’s local hospital
• NWB for 6 months, remained on an acute ortho
ward
• Transferred to intermediate care at 7 months –
little experience of younger patients and ortho
rehab
No specialist community MDT for MSK
rehabilitation leading to sub-optimal
outcomes and longer lengths of
rehabilitation
• If there were community MSK trauma rehab
teams, the outcome of the previous example may
have been somewhat different
Insufficient level 1 and 2 inpatient
rehabilitation facilities for neurotrauma
patients
• BSRM guidelines recommend 60 level 2 beds per
million population
• Currently 47 in the North East and Cumbria
• Level 1 facility is Walkgate Park = 35 beds
Insufficient specialist community teams for
neurotrauma patients
• Only available in 3 areas:
• Northumberland (3 therapies in one team)
• Gateshead (no physiotherapy)
• Cumbria
• Different models at each locality
• All teams work across health and social care
No robust system for data collection to
indicate the number of patients requiring
specialist and non-specialist Recovery,
Rehabilitation and Reablement
• TARN can provide a list of injuries and ISS, but
these don’t tell us what the patient’s rehabilitation
needs are and are retrospective
• UKROC not used by all aspects of the pathway
• Rehabilitation prescription yet to function as a
data recording tool
Lack of vocational rehabilitation resulting
in no focus on reablement, return to work
and social integration
• No vocational rehab for MSK trauma
• Limited for neurotrauma
• All have access to statutory services – not always
appropriate
• Momentum for neuro patients
No standardised or consistent approach to
the use of outcome measures which
makes it difficult to evaluate rehabilitation
• Different emphasis at each stage of rehab,
therefore a variety of outcome measures are used
• No standardised approach
• Work is being undertaken to determine best
outcome measures to use
Recommendations
Recommendations
•
Provide additional Consultant level leadership in
rehabilitation in order to promote inter-speciality working
and improve patient management and outcomes e.g.
Consultants in Rehabilitation Medicine/Consultant Allied
Health Professionals.
Recommendations
2. Explore workforce options to improve coordination and
communication across the whole pathway for example
Rehabilitation Coordinators/Facilitators.
3. Devise robust, flexible, fit for purpose systems to collect
data and inform future commissioning and service
provision.
Recommendations
4. Develop specialist rehabilitation inpatient beds for major
trauma MSK patients. This would also ensure the
capacity to provide intensive therapy. Further work is
recommended to identify the number of beds required.
5. Create specialist MDTs which would deliver specialist
rehabilitation for MSK major and serious trauma patients
(inpatient and outpatient/community).
Recommendations
6. Provision of more level 1 and 2 rehabilitation beds for
Neurotrauma patients in line with national
recommendations.
7. Increase the current number of specialist community
teams for rehabilitation of Neurotrauma patients to cover
all areas.
Recommendations
8. Undertake robust and committed service redesign to
deliver a best practice pathway, with particular focus on
strengthening Recovery, Rehabilitation and Reablement
services.
9. Ensure regional implementation of the rehabilitation
prescription process for all major trauma patients across
all services, from injury to re-enablement. This should
include the redesign of the current Rehabilitation
Prescription.
Recommendations
10. Integrate vocational rehabilitation into the trauma
pathway.
11. Undertake further work to develop recommendations for
the use of outcome measures for the trauma
rehabilitation pathway.
Recommendations
12. Develop a Directory of Rehabilitation Services with
identified administrative support to maintain and update.
Implementation of these recommendations requires a
coordinated approach involving commissioners, expert
clinicians and service users.