Rehabilitation workshop workstream overview

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