Major Trauma CentresUSA

Becky WilliamsonOccupational Therapist

Early Occupational Therapy rehabilitation within major trauma

centres of America

Introduction

bull Major Trauma - serious multiple system injuries

bull East Midlands Major Trauma Centrebull Queens Medical Centre - April 2012

bull America Major Trauma Centres amp Rehabilitationbull Much of the evidence from America

bull Nottinghamshire Roosevelt Scholarship

Objectives

bull Gain an international perspective

bull Compare and contact the use of OT core skills

bull Influence development of Major Trauma OT services at NUH

Methodbull Literature review of the existing evidence base

bull Examination of current practice amp services

bull Identification of key contacts and visits in America

bull Exploration of best practice building knowledge amp understanding of services in American

bull Dissemination of the scholarship findings to key stakeholders

Discussionbull Joint therapy promoted early mobilisation amp functional rehabilitation

bull OT role bull assessment of levels of awareness amp arousalbull splintingbull seating amp positioningbull cognitive amp early functional rehabilitationbull recommendations for managing behaviour bull support with emotional amp psychological wellbeing

bull Collaboration with bedside nurses facilitates 24 hour rehabilitation

bull OTs completed senior rotations across the acute setting

Evidencebull Department of Health

bull rehabilitation worst performing element of trauma pathway

bull Rehabilitation can reduce ldquosocietal cost significantlyrdquo (DOH 2009)

bull Rehabilitation prescriptions need to identify bull ldquoan appropriate programme of rehabilitation to assist their recoveryrdquo NHS Choices

(2012)

bull OT interventions needed in ICU stay to prevent deficits due to joint contracture amp initiate functional rehabilitation (Robinson et al 2006)

bull Early OT rehabilitation optimises functional outcomes (Hedges et al 2006)

Conclusion

bull OTs need specialist expertise to deliver best practice in early Major Trauma rehabilitation

bull OT role recruited to in the regional Major Trauma Centre

bull Opportunities for OT rehabilitation in ICU and HDU

bull Highlight the need for and benefits of rehabilitation bull Save money in the long term bull Better patient outcomes

Referencesbull Affordable Care Act (2010) Affordable Care Act Full Text [

httpwwwhealthcaregovlawfullindexhtml] Last Accessed 31042013 1700

bull Batalden P B amp Davidoff F (2007) What is ldquoquality improvementrdquo and how can it transform healthcare Quality and Safety in Health Care February 2007 16(1) 2ndash3

bull Brahmbhatt N Murugan R amp Milbrandt E (2010) Early mobilisation improves functional outcomes in critically ill patients Critical Care 2010 12321

bull DOH ndash Department of Health (2009) Rehabilitation of major trauma patients QIPP - NHS Evidence 27 November 2009 - Publisher Department of Health - Publication type Quality and Productivity Example [httpswwwevidencenhsukqipp] Last Accessed 31042013 1700

bull Frances Report (2013) Final Report of the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust [httpwwwmidstaffsinquirycompressreleasehtml] Last Accessed 31042013 1700

Early Occupational Therapy rehabilitation within major trauma

centres of America

Introduction

bull Major Trauma - serious multiple system injuries

bull East Midlands Major Trauma Centrebull Queens Medical Centre - April 2012

bull America Major Trauma Centres amp Rehabilitationbull Much of the evidence from America

bull Nottinghamshire Roosevelt Scholarship

Objectives

bull Gain an international perspective

bull Compare and contact the use of OT core skills

bull Influence development of Major Trauma OT services at NUH

Methodbull Literature review of the existing evidence base

bull Examination of current practice amp services

bull Identification of key contacts and visits in America

bull Exploration of best practice building knowledge amp understanding of services in American

bull Dissemination of the scholarship findings to key stakeholders

Discussionbull Joint therapy promoted early mobilisation amp functional rehabilitation

bull OT role bull assessment of levels of awareness amp arousalbull splintingbull seating amp positioningbull cognitive amp early functional rehabilitationbull recommendations for managing behaviour bull support with emotional amp psychological wellbeing

bull Collaboration with bedside nurses facilitates 24 hour rehabilitation

bull OTs completed senior rotations across the acute setting

Evidencebull Department of Health

bull rehabilitation worst performing element of trauma pathway

bull Rehabilitation can reduce ldquosocietal cost significantlyrdquo (DOH 2009)

bull Rehabilitation prescriptions need to identify bull ldquoan appropriate programme of rehabilitation to assist their recoveryrdquo NHS Choices

(2012)

bull OT interventions needed in ICU stay to prevent deficits due to joint contracture amp initiate functional rehabilitation (Robinson et al 2006)

bull Early OT rehabilitation optimises functional outcomes (Hedges et al 2006)

Conclusion

bull OTs need specialist expertise to deliver best practice in early Major Trauma rehabilitation

bull OT role recruited to in the regional Major Trauma Centre

bull Opportunities for OT rehabilitation in ICU and HDU

bull Highlight the need for and benefits of rehabilitation bull Save money in the long term bull Better patient outcomes

Referencesbull Affordable Care Act (2010) Affordable Care Act Full Text [

httpwwwhealthcaregovlawfullindexhtml] Last Accessed 31042013 1700

bull Batalden P B amp Davidoff F (2007) What is ldquoquality improvementrdquo and how can it transform healthcare Quality and Safety in Health Care February 2007 16(1) 2ndash3

bull Brahmbhatt N Murugan R amp Milbrandt E (2010) Early mobilisation improves functional outcomes in critically ill patients Critical Care 2010 12321

bull DOH ndash Department of Health (2009) Rehabilitation of major trauma patients QIPP - NHS Evidence 27 November 2009 - Publisher Department of Health - Publication type Quality and Productivity Example [httpswwwevidencenhsukqipp] Last Accessed 31042013 1700

bull Frances Report (2013) Final Report of the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust [httpwwwmidstaffsinquirycompressreleasehtml] Last Accessed 31042013 1700

Introduction

bull Major Trauma - serious multiple system injuries

bull East Midlands Major Trauma Centrebull Queens Medical Centre - April 2012

bull America Major Trauma Centres amp Rehabilitationbull Much of the evidence from America

bull Nottinghamshire Roosevelt Scholarship

Objectives

bull Gain an international perspective

bull Compare and contact the use of OT core skills

bull Influence development of Major Trauma OT services at NUH

Methodbull Literature review of the existing evidence base

bull Examination of current practice amp services

bull Identification of key contacts and visits in America

bull Exploration of best practice building knowledge amp understanding of services in American

bull Dissemination of the scholarship findings to key stakeholders

Discussionbull Joint therapy promoted early mobilisation amp functional rehabilitation

bull OT role bull assessment of levels of awareness amp arousalbull splintingbull seating amp positioningbull cognitive amp early functional rehabilitationbull recommendations for managing behaviour bull support with emotional amp psychological wellbeing

bull Collaboration with bedside nurses facilitates 24 hour rehabilitation

bull OTs completed senior rotations across the acute setting

Evidencebull Department of Health

bull rehabilitation worst performing element of trauma pathway

bull Rehabilitation can reduce ldquosocietal cost significantlyrdquo (DOH 2009)

bull Rehabilitation prescriptions need to identify bull ldquoan appropriate programme of rehabilitation to assist their recoveryrdquo NHS Choices

(2012)

bull OT interventions needed in ICU stay to prevent deficits due to joint contracture amp initiate functional rehabilitation (Robinson et al 2006)

bull Early OT rehabilitation optimises functional outcomes (Hedges et al 2006)

Conclusion

bull OTs need specialist expertise to deliver best practice in early Major Trauma rehabilitation

bull OT role recruited to in the regional Major Trauma Centre

bull Opportunities for OT rehabilitation in ICU and HDU

bull Highlight the need for and benefits of rehabilitation bull Save money in the long term bull Better patient outcomes

Referencesbull Affordable Care Act (2010) Affordable Care Act Full Text [

httpwwwhealthcaregovlawfullindexhtml] Last Accessed 31042013 1700

bull Batalden P B amp Davidoff F (2007) What is ldquoquality improvementrdquo and how can it transform healthcare Quality and Safety in Health Care February 2007 16(1) 2ndash3

bull Brahmbhatt N Murugan R amp Milbrandt E (2010) Early mobilisation improves functional outcomes in critically ill patients Critical Care 2010 12321

bull DOH ndash Department of Health (2009) Rehabilitation of major trauma patients QIPP - NHS Evidence 27 November 2009 - Publisher Department of Health - Publication type Quality and Productivity Example [httpswwwevidencenhsukqipp] Last Accessed 31042013 1700

bull Frances Report (2013) Final Report of the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust [httpwwwmidstaffsinquirycompressreleasehtml] Last Accessed 31042013 1700

Objectives

bull Gain an international perspective

bull Compare and contact the use of OT core skills

bull Influence development of Major Trauma OT services at NUH

Methodbull Literature review of the existing evidence base

bull Examination of current practice amp services

bull Identification of key contacts and visits in America

bull Exploration of best practice building knowledge amp understanding of services in American

bull Dissemination of the scholarship findings to key stakeholders

Discussionbull Joint therapy promoted early mobilisation amp functional rehabilitation

bull OT role bull assessment of levels of awareness amp arousalbull splintingbull seating amp positioningbull cognitive amp early functional rehabilitationbull recommendations for managing behaviour bull support with emotional amp psychological wellbeing

bull Collaboration with bedside nurses facilitates 24 hour rehabilitation

bull OTs completed senior rotations across the acute setting

Evidencebull Department of Health

bull rehabilitation worst performing element of trauma pathway

bull Rehabilitation can reduce ldquosocietal cost significantlyrdquo (DOH 2009)

bull Rehabilitation prescriptions need to identify bull ldquoan appropriate programme of rehabilitation to assist their recoveryrdquo NHS Choices

(2012)

bull OT interventions needed in ICU stay to prevent deficits due to joint contracture amp initiate functional rehabilitation (Robinson et al 2006)

bull Early OT rehabilitation optimises functional outcomes (Hedges et al 2006)

Conclusion

bull OTs need specialist expertise to deliver best practice in early Major Trauma rehabilitation

bull OT role recruited to in the regional Major Trauma Centre

bull Opportunities for OT rehabilitation in ICU and HDU

bull Highlight the need for and benefits of rehabilitation bull Save money in the long term bull Better patient outcomes

Referencesbull Affordable Care Act (2010) Affordable Care Act Full Text [

httpwwwhealthcaregovlawfullindexhtml] Last Accessed 31042013 1700

bull Batalden P B amp Davidoff F (2007) What is ldquoquality improvementrdquo and how can it transform healthcare Quality and Safety in Health Care February 2007 16(1) 2ndash3

bull Brahmbhatt N Murugan R amp Milbrandt E (2010) Early mobilisation improves functional outcomes in critically ill patients Critical Care 2010 12321

bull DOH ndash Department of Health (2009) Rehabilitation of major trauma patients QIPP - NHS Evidence 27 November 2009 - Publisher Department of Health - Publication type Quality and Productivity Example [httpswwwevidencenhsukqipp] Last Accessed 31042013 1700

bull Frances Report (2013) Final Report of the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust [httpwwwmidstaffsinquirycompressreleasehtml] Last Accessed 31042013 1700

Methodbull Literature review of the existing evidence base

bull Examination of current practice amp services

bull Identification of key contacts and visits in America

bull Exploration of best practice building knowledge amp understanding of services in American

bull Dissemination of the scholarship findings to key stakeholders

Discussionbull Joint therapy promoted early mobilisation amp functional rehabilitation

bull OT role bull assessment of levels of awareness amp arousalbull splintingbull seating amp positioningbull cognitive amp early functional rehabilitationbull recommendations for managing behaviour bull support with emotional amp psychological wellbeing

bull Collaboration with bedside nurses facilitates 24 hour rehabilitation

bull OTs completed senior rotations across the acute setting

Evidencebull Department of Health

bull rehabilitation worst performing element of trauma pathway

bull Rehabilitation can reduce ldquosocietal cost significantlyrdquo (DOH 2009)

bull Rehabilitation prescriptions need to identify bull ldquoan appropriate programme of rehabilitation to assist their recoveryrdquo NHS Choices

(2012)

bull OT interventions needed in ICU stay to prevent deficits due to joint contracture amp initiate functional rehabilitation (Robinson et al 2006)

bull Early OT rehabilitation optimises functional outcomes (Hedges et al 2006)

Conclusion

bull OTs need specialist expertise to deliver best practice in early Major Trauma rehabilitation

bull OT role recruited to in the regional Major Trauma Centre

bull Opportunities for OT rehabilitation in ICU and HDU

bull Highlight the need for and benefits of rehabilitation bull Save money in the long term bull Better patient outcomes

Referencesbull Affordable Care Act (2010) Affordable Care Act Full Text [

httpwwwhealthcaregovlawfullindexhtml] Last Accessed 31042013 1700

bull Batalden P B amp Davidoff F (2007) What is ldquoquality improvementrdquo and how can it transform healthcare Quality and Safety in Health Care February 2007 16(1) 2ndash3

bull Brahmbhatt N Murugan R amp Milbrandt E (2010) Early mobilisation improves functional outcomes in critically ill patients Critical Care 2010 12321

bull DOH ndash Department of Health (2009) Rehabilitation of major trauma patients QIPP - NHS Evidence 27 November 2009 - Publisher Department of Health - Publication type Quality and Productivity Example [httpswwwevidencenhsukqipp] Last Accessed 31042013 1700

bull Frances Report (2013) Final Report of the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust [httpwwwmidstaffsinquirycompressreleasehtml] Last Accessed 31042013 1700

Discussionbull Joint therapy promoted early mobilisation amp functional rehabilitation

bull OT role bull assessment of levels of awareness amp arousalbull splintingbull seating amp positioningbull cognitive amp early functional rehabilitationbull recommendations for managing behaviour bull support with emotional amp psychological wellbeing

bull Collaboration with bedside nurses facilitates 24 hour rehabilitation

bull OTs completed senior rotations across the acute setting

Evidencebull Department of Health

bull rehabilitation worst performing element of trauma pathway

bull Rehabilitation can reduce ldquosocietal cost significantlyrdquo (DOH 2009)

bull Rehabilitation prescriptions need to identify bull ldquoan appropriate programme of rehabilitation to assist their recoveryrdquo NHS Choices

(2012)

bull OT interventions needed in ICU stay to prevent deficits due to joint contracture amp initiate functional rehabilitation (Robinson et al 2006)

bull Early OT rehabilitation optimises functional outcomes (Hedges et al 2006)

Conclusion

bull OTs need specialist expertise to deliver best practice in early Major Trauma rehabilitation

bull OT role recruited to in the regional Major Trauma Centre

bull Opportunities for OT rehabilitation in ICU and HDU

bull Highlight the need for and benefits of rehabilitation bull Save money in the long term bull Better patient outcomes

Referencesbull Affordable Care Act (2010) Affordable Care Act Full Text [

httpwwwhealthcaregovlawfullindexhtml] Last Accessed 31042013 1700

bull Batalden P B amp Davidoff F (2007) What is ldquoquality improvementrdquo and how can it transform healthcare Quality and Safety in Health Care February 2007 16(1) 2ndash3

bull Brahmbhatt N Murugan R amp Milbrandt E (2010) Early mobilisation improves functional outcomes in critically ill patients Critical Care 2010 12321

bull DOH ndash Department of Health (2009) Rehabilitation of major trauma patients QIPP - NHS Evidence 27 November 2009 - Publisher Department of Health - Publication type Quality and Productivity Example [httpswwwevidencenhsukqipp] Last Accessed 31042013 1700

bull Frances Report (2013) Final Report of the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust [httpwwwmidstaffsinquirycompressreleasehtml] Last Accessed 31042013 1700

Evidencebull Department of Health

bull rehabilitation worst performing element of trauma pathway

bull Rehabilitation can reduce ldquosocietal cost significantlyrdquo (DOH 2009)

bull Rehabilitation prescriptions need to identify bull ldquoan appropriate programme of rehabilitation to assist their recoveryrdquo NHS Choices

(2012)

bull OT interventions needed in ICU stay to prevent deficits due to joint contracture amp initiate functional rehabilitation (Robinson et al 2006)

bull Early OT rehabilitation optimises functional outcomes (Hedges et al 2006)

Conclusion

bull OTs need specialist expertise to deliver best practice in early Major Trauma rehabilitation

bull OT role recruited to in the regional Major Trauma Centre

bull Opportunities for OT rehabilitation in ICU and HDU

bull Highlight the need for and benefits of rehabilitation bull Save money in the long term bull Better patient outcomes

Referencesbull Affordable Care Act (2010) Affordable Care Act Full Text [

httpwwwhealthcaregovlawfullindexhtml] Last Accessed 31042013 1700

bull Batalden P B amp Davidoff F (2007) What is ldquoquality improvementrdquo and how can it transform healthcare Quality and Safety in Health Care February 2007 16(1) 2ndash3

bull Brahmbhatt N Murugan R amp Milbrandt E (2010) Early mobilisation improves functional outcomes in critically ill patients Critical Care 2010 12321

bull DOH ndash Department of Health (2009) Rehabilitation of major trauma patients QIPP - NHS Evidence 27 November 2009 - Publisher Department of Health - Publication type Quality and Productivity Example [httpswwwevidencenhsukqipp] Last Accessed 31042013 1700

bull Frances Report (2013) Final Report of the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust [httpwwwmidstaffsinquirycompressreleasehtml] Last Accessed 31042013 1700

Conclusion

bull OTs need specialist expertise to deliver best practice in early Major Trauma rehabilitation

bull OT role recruited to in the regional Major Trauma Centre

bull Opportunities for OT rehabilitation in ICU and HDU

bull Highlight the need for and benefits of rehabilitation bull Save money in the long term bull Better patient outcomes

Referencesbull Affordable Care Act (2010) Affordable Care Act Full Text [

httpwwwhealthcaregovlawfullindexhtml] Last Accessed 31042013 1700

bull Batalden P B amp Davidoff F (2007) What is ldquoquality improvementrdquo and how can it transform healthcare Quality and Safety in Health Care February 2007 16(1) 2ndash3

bull Brahmbhatt N Murugan R amp Milbrandt E (2010) Early mobilisation improves functional outcomes in critically ill patients Critical Care 2010 12321

bull DOH ndash Department of Health (2009) Rehabilitation of major trauma patients QIPP - NHS Evidence 27 November 2009 - Publisher Department of Health - Publication type Quality and Productivity Example [httpswwwevidencenhsukqipp] Last Accessed 31042013 1700

bull Frances Report (2013) Final Report of the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust [httpwwwmidstaffsinquirycompressreleasehtml] Last Accessed 31042013 1700

Referencesbull Affordable Care Act (2010) Affordable Care Act Full Text [

httpwwwhealthcaregovlawfullindexhtml] Last Accessed 31042013 1700

bull Batalden P B amp Davidoff F (2007) What is ldquoquality improvementrdquo and how can it transform healthcare Quality and Safety in Health Care February 2007 16(1) 2ndash3

bull Brahmbhatt N Murugan R amp Milbrandt E (2010) Early mobilisation improves functional outcomes in critically ill patients Critical Care 2010 12321

bull DOH ndash Department of Health (2009) Rehabilitation of major trauma patients QIPP - NHS Evidence 27 November 2009 - Publisher Department of Health - Publication type Quality and Productivity Example [httpswwwevidencenhsukqipp] Last Accessed 31042013 1700

bull Frances Report (2013) Final Report of the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust [httpwwwmidstaffsinquirycompressreleasehtml] Last Accessed 31042013 1700

Referencesbull Hedges J Krog K Megargee T Porras-Monroe M amp Foisie Robinson E (2006) Chapter 4 ndash

Early Rehabilitation Interventions Located in Robinson L (2006) Trauma Rehabilitation 1st ed Philadelphia PA Lippincott Williams amp Wilkins

bull NHS Choices (2012) Major Trauma Services Reviewed by authors - 10042012 [httpwwwnhsukNHSEnglandAboutNHSservicesEmergencyandurgentcareservicesPagesMajortraumaservicesaspx] Last Accessed 19092012 1700

bull Nottinghamshire Roosevelt Travelling Scholarship (2012) [httprooseveltscholarshiporg] Last Accessed 30042013 1700

bull Robinson L (2006) Trauma Rehabilitation 1st ed Philadelphia PA Lippincott Williams amp Wilkins

bull Schweickert WD Pohlman MC Pohlman AS Nigos C Pawlik AJ Esbrook CL Spears L Miller M Franczyk M Deprizio D Schmidt GA Bowman A Barr R McCallister KE Hall JB amp Kress JP (2009) Early physical and occupational therapy in mechanically ventilated critically ill patients a randomised controlled trial Lancet 2009 May 30373(9678)1874-82

Link to Report amp Blog

bull Report

httpwwwrooseveltscholarshiporgresourcesdocumentsRooseveltReport-RebeccaWilliamsonpdf

bull Blog

httpblogtravelpodcommembersbeckywilliamson

Becky Williamson - OT

rebeccawilliamsonnuhnhsuk

_beckyOT

• Major Trauma Centres USA
• Early Occupational Therapy rehabilitation within major trauma centres of America
• Introduction
• PowerPoint Presentation
• Slide 5
• Objectives
• Method
• Slide 8
• Slide 9
• Slide 10
• Discussion
• Evidence
• Conclusion
• Slide 14
• Slide 15
• References
• Slide 17
• Link to Report amp Blog
• Slide 19

Becky Williamson - OT

rebeccawilliamsonnuhnhsuk

_beckyOT

• Major Trauma Centres USA
• Early Occupational Therapy rehabilitation within major trauma centres of America
• Introduction
• PowerPoint Presentation
• Slide 5
• Objectives
• Method
• Slide 8
• Slide 9
• Slide 10
• Discussion
• Evidence
• Conclusion
• Slide 14
• Slide 15
• References
• Slide 17
• Link to Report amp Blog
• Slide 19