Major Trauma Project Rehabilitation Workstream

Jane Barnacle Beth CordreyRehab Workstream Lead Senior Clinical Adviser

Major Trauma Project 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 StructureDevelopment of acute rehabilitation facilities

Common standards and policies

Governance opportunities

Shared care models

2. WorkforceDevelopment of workforce model

Workforce development plan

Case management/coordination

3. InformationDevelopment of common data standards across the system

Directory of services

4. CapacityWhen 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

MTC

TC

IP Rehab

Community Services

Milestones

Interventions

Competencies

System enablers

Stabilisation

Rehabilitation(including optimisation for rehab)

Reintegration

Prin

ciples, policies, procedure

s, structures

Navigation

Documentation (including prescription for rehabilitation)

Data (using TARN)

Governance

Continuing P

rofessiona

l Developm

ent

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

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)

Vascular and amputees (including general surgical patients)

X

Gym on site equipped to provide acute phase assessment and rehabilitation to

trauma patients X

Major Trauma Rehabilitation Model

MTC

TC

IP Rehab

Community Services

Milestones

Interventions

Competencies

System enablers

Stabilisation

Rehabilitation(including optimisation for rehab)

Reintegration

Prin

ciples, policies, procedure

s, structures

Navigation

Documentation (including prescription for rehabilitation)

Data (using TARN)

Governance

Continuing P

rofessiona

l Developm

ent

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

MTC

TC

IP Rehab

Community Services

Milestones

Interventions

Competencies

System enablers

Stabilisation

Rehabilitation(including optimisation for rehab)

Reintegration

Prin

ciples, policies, procedure

s, structures

Navigation

Documentation (including prescription for rehabilitation)

Data (using TARN)

Governance

Continuing P

rofessiona

l Developm

ent

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

MTC

TC

IP Rehab

Community Services

Milestones

Interventions

Competencies

System enablers

Stabilisation

Rehabilitation(including optimisation for rehab)

Reintegration

Prin

ciples, policies, procedure

s, structures

Navigation

Documentation (including prescription for rehabilitation)

Data (using TARN)

Governance

Continuing P

rofessiona

l Developm

ent

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

MTC

TC

IP Rehab

Community Services

Milestones

Interventions

Competencies

System enablers

Stabilisation

Rehabilitation(including optimisation for rehab)

Reintegration

Prin

ciples, policies, procedure

s, structures

Navigation

Documentation (including prescription for rehabilitation)

Data (using TARN)

Governance

Continuing P

rofessiona

l Developm

ent

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

MTC

TC

IP Rehab

Community Services

Milestones

Interventions

Competencies

System enablers

Stabilisation

Rehabilitation(including optimisation for rehab)

Reintegration

Prin

ciples, policies, procedure

s, structures

Navigation

Documentation (including prescription for rehabilitation)

Data (using TARN)

Governance

Continuing P

rofessiona

l Developm

ent

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

MTC

TC

IP Rehab

Community Services

Milestones

Interventions

Competencies

System enablers

Stabilisation

Rehabilitation(including optimisation for rehab)

Reintegration

Prin

ciples, policies, procedure

s, structures

Navigation

Documentation (including prescription for rehabilitation)

Data (using TARN)

Governance

Continuing P

rofessiona

l Developm

ent

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

MTC

TC

IP Rehab

Community Services

Milestones

Interventions

Competencies

System enablers

Stabilisation

Rehabilitation(including optimisation for rehab)

Reintegration

Prin

ciples, policies, procedure

s, structures

Navigation

Documentation (including prescription for rehabilitation)

Data (using TARN)

Governance

Continuing P

rofessiona

l Developm

ent

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

MTC

TC

IP Rehab

Community Services

Milestones

Interventions

Competencies

System enablers

Stabilisation

Rehabilitation(including optimisation for rehab)

Reintegration

Prin

ciples, policies, procedure

s, structures

Navigation

Documentation (including prescription for rehabilitation)

Data (using TARN)

Governance

Continuing P

rofessiona

l Developm

ent

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