Major Trauma Project
Rehabilitation Workstream
Jane Barnacle
Beth Cordrey
Rehab Workstream Lead
Major Trauma Project
Senior Clinical Adviser
Major Trauma Project
Overarching conclusions
• Broad spectrum of rehabilitation needs
• Rarely common or predictable pathways
• Inappropriate and inefficient use of existing services
• A more collaborative and flexible approach is required
• Consistent service standards and improved data
management urgently required
Vision for the future
• a proactively managed system
• consistently high quality care and rehabilitation
• most appropriate setting, at the most appropriate time
• system works across boundaries
• care and rehabilitation provided as close to home as
possible, as soon as is clinically appropriate.
Proposed strategy for trauma rehab services
1. Service Delivery Models and
Structure
Development of acute rehabilitation facilities
Common standards and policies
Governance opportunities
2. Workforce
Development of workforce model
Workforce development plan
Case management/coordination
Shared care models
3. Information
4. Capacity
Development of common data standards
across the system
Directory of services
When able to, carry out detailed
capacity analysis of services
contributing to major trauma
rehabilitation
Project Phases
• Current Phase: May – mid August
• Future Phase: August onwards
Major Trauma Rehabilitation Model
Rehabilitation
(including optimisation for rehab)
Reintegration
Stabilisation
MTC
IP Rehab
Community
Services
TC
Interventions
Competencies
System enablers
Documentation (including prescription for rehabilitation)
Navigation
Data
(using TARN)
Governance
Continuing Professional Development
Principles, policies, procedures, structures
Milestones
Project Deliverable 1
Service Specification
•
•
•
Original Designation Criteria was limited on rehabilitation
Opportunity for development
Initial focus on Major Trauma Centres and Trauma Centres
Criteria
Number
Description
Major Trauma
Centre
79.
Physiotherapy
Gym
Gym on site equipped to provide acute phase assessment and acute phase
rehabilitation to major trauma patients including management of the following
injuries/patient groups:
–Spinal injury
–Traumatic brain injury
–Complex musculoskeletal (e.g. pelvic fracture, soft tissue injury)
X
Trauma
Centre
Vascular and amputees (including general surgical patients)
Gym on site equipped to provide acute phase assessment and rehabilitation to
trauma patients
X
Major Trauma Rehabilitation Model
Rehabilitation
(including optimisation for rehab)
Reintegration
Stabilisation
MTC
IP Rehab
Community
Services
TC
Interventions
Competencies
System enablers
Documentation (including prescription for rehabilitation)
Navigation
Data
(using TARN)
Governance
Continuing Professional Development
Principles, policies, procedures, structures
Milestones
Project Deliverable 2
Acute Rehabilitation Model
•
Distinct from the ‘acute phase’ rehabilitation in MTC
•
Takes principles of formal rehabilitation models
•
Accessible by all major trauma patients
•
Demand for London networks not yet known
Major Trauma Rehabilitation Model
Rehabilitation
(including optimisation for rehab)
Reintegration
Stabilisation
MTC
IP Rehab
Community
Services
TC
Interventions
Competencies
System enablers
Documentation (including prescription for rehabilitation)
Navigation
Data
(using TARN)
Governance
Continuing Professional Development
Principles, policies, procedures, structures
Milestones
Project Deliverable 3
Trauma Rehab Pathway
•
Mapping the entire pathway from critical care through to community
•
Encompass existing guidance/ standards i.e. National Service Framework
for Long Term Conditions (2005), The NICE Guidance on Critical Care
Rehabilitation (2009) and the British Society of Rehabilitation Medicine's Standards
for Rehabilitation Services (2009)
•
Using a model that focuses on key patient milestones,
interventions, competencies and systems enablers
Major Trauma Rehabilitation Model
Rehabilitation
(including optimisation for rehab)
Reintegration
Stabilisation
MTC
IP Rehab
Community
Services
TC
Interventions
Competencies
System enablers
Documentation (including prescription for rehabilitation)
Navigation
Data
(using TARN)
Governance
Continuing Professional Development
Principles, policies, procedures, structures
Milestones
Project Deliverable 4
Data
• Performance metrics for rehabilitation
• Trauma Audit and Research Network (TARN)
• Identifying useful data to assess performance
• Links to the pathway being developed
Major Trauma Rehabilitation Model
Rehabilitation
(including optimisation for rehab)
Reintegration
Stabilisation
MTC
IP Rehab
Community
Services
TC
Interventions
Competencies
System enablers
Documentation (including prescription for rehabilitation)
Navigation
Data (using TARN)
Governance
Continuing Professional Development
Principles, policies, procedures, structures
Milestones
Project Deliverable 5
Navigation Model
• Patient focussed advocate
• Facilitation of progression along the pathway: transitions
• Optimises patient experience and use of facilities and resources
Major Trauma Rehabilitation Model
Rehabilitation
(including optimisation for rehab)
Reintegration
Stabilisation
MTC
IP Rehab
Community
Services
TC
Interventions
Competencies
System enablers
Documentation (including prescription for rehabilitation)
Navigation
Data (using TARN)
Governance
Continuing Professional Development
Principles, policies, procedures, structures
Milestones
Project Deliverable 6
Directory of Services
• Directory of Health and Social Care Services to support the London
Trauma System
• Giving clinicians easy access to up to date and local information
about services relevant to this client group
• May be outsourced & will need maintaining
Major Trauma Rehabilitation Model
Rehabilitation
(including optimisation for rehab)
Reintegration
Stabilisation
MTC
IP Rehab
Community
Services
TC
Interventions
Competencies
System enablers
Documentation (including prescription for rehabilitation)
Navigation
Data (using TARN)
Governance
Continuing Professional Development
Principles, policies, procedures, structures
Milestones
Project Deliverable 7
Documentation
• For facilitating pathways and data collection in a more consistent
manner
• Trauma booklet for London Trauma System
• Prescription for Rehabilitation
Major Trauma Rehabilitation Model
Rehabilitation
(including optimisation for rehab)
Reintegration
Stabilisation
MTC
IP Rehab
Community
Services
TC
Interventions
Competencies
System enablers
Documentation (including prescription for rehabilitation)
Navigation
Data (using TARN)
Governance
Continuing Professional Development
Principles, policies, procedures, structures
Milestones
Project Deliverable 8
Rehabilitation Clinical Governance Framework
• Network level
• Tracking patients and reviewing outcomes and quality of
rehabilitation provided at each stage of the pathway
• Reporting into an overarching performance framework at
the London Trauma System
Major Trauma Rehabilitation Model
Rehabilitation
(including optimisation for rehab)
Reintegration
Stabilisation
MTC
IP Rehab
Community
Services
TC
Interventions
Competencies
System enablers
Documentation (including prescription for rehabilitation)
Navigation
Data (using TARN)
Governance
Continuing Professional Development
Principles, policies, procedures, structures
Milestones
Project Deliverable 9 &10
Evaluation
• Impact and cost-benefit analysis to inform commissioning
decisions
Future Work
•
•
•
•
•
Carrying on the work commenced …
Analysis of demand & capacity (data dependent)
Workforce review and development
Ongoing development of standards
Patient Outcomes - commissioning for outcomes