Trauma Rehabilitation - One Year Review

Fahim AnwarConsultant in Rehabilitation Medicine

Addenbrooke's HospitalCambridge

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 PathwayProblems

•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

• 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.uk

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 PrescriptionBiggest Achievement

Paper version Web based version

Rehabilitation Prescription Protocols

Rehabilitation prescription implementation

n=526

Live 26/6/13

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 MTCn=729

RAAR Discharge Destinationn=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