Major Trauma Project Rehabilitation Workstream

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Major Trauma Project Rehabilitation Workstream

• Jane Barnacle Beth Cordrey
• Rehab Workstream Lead Senior Clinical Adviser
• Major Trauma Project Major Trauma Project

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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

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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.

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Proposed strategy for trauma rehab services
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Project Phases

• Current Phase May mid August
• Future Phase August onwards

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Major Trauma Rehabilitation Model
Rehabilitation (including optimisation for rehab)
Reintegration
Stabilisation
Principles, policies, procedures, structures
Continuing Professional Development
MTC
IP Rehab
Community Services
TC
Documentation (including prescription for
rehabilitation)
Navigation
Data (using TARN)
Governance
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Project Deliverable 1

• Service Specification
• Original Designation Criteria was limited on
  rehabilitation
• Opportunity for development
• Initial focus on Major Trauma Centres and Trauma
  Centres

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Major Trauma Rehabilitation Model
Rehabilitation (including optimisation for rehab)
Reintegration
Stabilisation
Principles, policies, procedures, structures
Continuing Professional Development
MTC
IP Rehab
Community Services
TC
Documentation (including prescription for
rehabilitation)
Navigation
Data (using TARN)
Governance
9
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

10
Major Trauma Rehabilitation Model
Rehabilitation (including optimisation for rehab)
Reintegration
Stabilisation
Principles, policies, procedures, structures
Continuing Professional Development
MTC
IP Rehab
Community Services
TC
Documentation (including prescription for
rehabilitation)
Navigation
Data (using TARN)
Governance
11
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

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Major Trauma Rehabilitation Model
Rehabilitation (including optimisation for rehab)
Reintegration
Stabilisation
Principles, policies, procedures, structures
Continuing Professional Development
MTC
IP Rehab
Community Services
TC
Documentation (including prescription for
rehabilitation)
Navigation
Data (using TARN)
Governance
13
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

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Major Trauma Rehabilitation Model
Rehabilitation (including optimisation for rehab)
Reintegration
Stabilisation
Principles, policies, procedures, structures
Continuing Professional Development
MTC
IP Rehab
Community Services
TC
Documentation (including prescription for
rehabilitation)
Navigation
Data (using TARN)
Governance
15
Project Deliverable 5

• Navigation Model
• Patient focussed advocate
• Facilitation of progression along the pathway
  transitions
• Optimises patient experience and use of
  facilities and resources

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Major Trauma Rehabilitation Model
Rehabilitation (including optimisation for rehab)
Reintegration
Stabilisation
Principles, policies, procedures, structures
Continuing Professional Development
MTC
IP Rehab
Community Services
TC
Documentation (including prescription for
rehabilitation)
Navigation
Data (using TARN)
Governance
17
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

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Major Trauma Rehabilitation Model
Rehabilitation (including optimisation for rehab)
Reintegration
Stabilisation
Principles, policies, procedures, structures
Continuing Professional Development
MTC
IP Rehab
Community Services
TC
Documentation (including prescription for
rehabilitation)
Navigation
Data (using TARN)
Governance
19
Project Deliverable 7

• Documentation
• For facilitating pathways and data collection in
  a more consistent manner
• Trauma booklet for London Trauma System
• Prescription for Rehabilitation

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Major Trauma Rehabilitation Model
Rehabilitation (including optimisation for rehab)
Reintegration
Stabilisation
Principles, policies, procedures, structures
Continuing Professional Development
MTC
IP Rehab
Community Services
TC
Documentation (including prescription for
rehabilitation)
Navigation
Data (using TARN)
Governance
21
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

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Major Trauma Rehabilitation Model
Rehabilitation (including optimisation for rehab)
Reintegration
Stabilisation
Principles, policies, procedures, structures
Continuing Professional Development
MTC
IP Rehab
Community Services
TC
Documentation (including prescription for
rehabilitation)
Navigation
Data (using TARN)
Governance
23
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