Trauma Rehabilitation - One Year
Review
Fahim Anwar
Consultant in Rehabilitation Medicine
Addenbrooke's Hospital
Cambridge
Agenda
• Overview of the EoE Major Trauma Network
• Rapid Access Acute Rehabilitation Ward (RAAR)
• Achievements and Challenges
• Aspirations
Continuum of care for major
trauma traditional pathway
Each component of care working in isolation and without
coordination
Major Trauma Traditional Pathway
• Emergency / acute management
• Neuro ICU / General ICU
• Neurosurgical / General Surgical / Orthopaedics ward
• DGH Bed
In any ward (lack of continuity, lack of expertise)
• Specialist Rehabilitation (services patchy)
Major Trauma Traditional Pathway
Problems
• Delay in transfer from neurosurgical bed to DGH (cost
implication and capacity issues)
• Prolonged inpatient stay
• Lack of expertise leading to delay in start of rehabilitation,
comorbidities and complications
• Lack of appropriate information and support
• Extremely stressful for families
Shift in Continuum of care for
major trauma
Rehabilitation team involvement within 48 hours
East of England Trauma Network
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5.9 million people
7,400 sq miles
>500 miles coastline
1 ambulance service
18 Acute NHS Trusts
1 Major Trauma Centre
12 Trauma Units
1 Level 1 rehab unit
8 Level 2b rehab beds
Spinal cord injuries centre
Sheffield
Stoke Mandeville
Trauma Triage Tool
East of England Inclusive Trauma
Network
Achievements of EOE Trauma
Network Coordination Services
Contact: 0300 330 3999
Achievements of EoE Trauma
Network
• TEMPO
• Directory of Services
• http//:www.eoetraumanetwork.nhs.u
k
Achievements of EoE Trauma
Network
• Strong rehabilitation focus
• TARN office identification of all trauma patients within the trust
• All trauma patients with ISS of more than 8 seen by
rehabilitation medicine consultant within 48 hours and a
rehabilitation prescription started
• Every trauma patient should leave the MTC with a rehabilitation
prescription
Rapid Access Acute Rehabilitation
Unit (J2 Ward in Addenbrooke’s)
• Timely and expert assessment of the rehabilitation needs of
trauma patients
• Acute rehabilitation interventions to maximise recovery and
minimise complications
• Provision of coordinated and specialised rehabilitation advice
and information to all involved in managing complex Major
Trauma
• Timely and appropriate transfer/discharge of patients to ensure
on-going rehabilitation needs are met
Rapid Access Acute Rehabilitation
Unit (J2 Ward in Addenbrooke’s)
• 21 beds opened in October 2012
• 10 beds commissioned by NHS England for Trauma Patients
• 11 capacity beds for the trust (used for trauma patients)
• 8 neuro-rehab beds (Level 2b) in Lewin ward being transferred
to J2
• Full MDT (lead by consultant in rehabilitation medicine)
including nurses, physio, OT, SALT, psychologist, dieticians,
social worker, headway liaison person
Rapid Access Acute Rehabilitation
Unit (J2 Ward in Addenbrooke’s)
• Shared care model
• 28 days maximum stay for trauma patients
• Early transfer of patients from acute settings to the rehabilitation
environment
• Appropriate environment for patients in post-traumatic amnesia
• Capability of caring for two trachy patients simultaneously in J2
• Appropriate environment for other diagnostic groups such as
SAH and non-traumatic spinal cord injury
• Capacity will reduce with Lewin beds to J2
RAAR Pathways for Trauma Patients
Responsibilities of Trauma Units
• Patient flow agreement
• On-going rehabilitation and re-enablement
• Delivering the rehabilitation prescription
• Clinical governance across the network
Achievements in the last year
• Saturday morning rehabilitation consultant ward round
• Trauma Rehabilitation Education Group (elearning and workshops)
• Ward based junior staff
• Trauma rehabilitation coordinator (Helen Young)
• Trauma Links in the trauma units
• Peer review (rehabilitation highly appreciated)
Rehabilitation Prescription
Biggest Achievement
Paper version
Web based version
Rehabilitation Prescription Protocols
Rehabilitation prescription implementation
140
120
Number of pa ents
100
80
60
40
20
0
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Live 26/6/13
n=526
One Year of Trauma Network
• October 2012 to October 2013
• Total trauma patients via MTC = 729
• Total trauma patients admitted to RAAR = 253 (34%)
Type of Injuries (n-729)
Discharge destinations from MTC
n=729
RAAR Discharge Destination
n=253
RAAR Discharge Destination N=253
Discharged Home
155
61.20%
Repatriation
59
23.30%
Discharged directly to
rehabilitation unit
35
13.83%
Nursing Home
3
1.1%
Mental Health Setting
1
0.39%
RAAR Repatriations
n=52
Repatriation wait in weeks for
Level 1 Rehab Unit Oct 12 to Oct
13
RAAR Length of Stay
• Minimum
1 day
• Maximum
99 days
• Mean LOS
17.84 days
•
85% discharged within 30 days.
Challenges faced in the first year
• Tracheostomy patients
• Patients with challenging behaviour
• Patients with prolonged post-traumatic amnesia
• Lack of Level 1 rehabilitation beds in EoE
• Lack of spinal injuries unit in EoE
• Team development
Aspirations
• Develop tracheostomy and challenging behaviour pathways
• Roll out RP to trauma units and community settings
• Patient and families information leaflet at the point of admission
to RAAR
• Support business case for spinal injuries unit in the EoE
• To achieve level 1 status for 8 neuro-rehab beds by submitting
full UKROC data
Aspirations
• Outcome data at one year follow up
• Publish audit and define research question
Fahim.anwar@addenbrookes.nhs.uk