Trauma Rehabilitation - One Year Review

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Trauma Rehabilitation - One Year Review

• Fahim Anwar
• Consultant in Rehabilitation Medicine
• Addenbrooke's Hospital
• Cambridge

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Agenda

• Overview of the EoE Major Trauma Network
• Rapid Access Acute Rehabilitation Ward (RAAR)
• Achievements and Challenges
• Aspirations

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Continuum of care for major trauma traditional
pathway
Each component of care working in isolation and
without coordination
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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)

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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

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What is the solution? Where must rehabilitation
start??
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Shift in Continuum of care for major trauma
Rehabilitation team involvement within 48 hours
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East of England Trauma Network

• 5.9 million people
• 7,400 sq miles
• gt500 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

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Trauma Triage Tool
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Achievements of EOE Trauma Network Coordination
Services
Contact 0300 330 3999
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Achievements of EoE Trauma Network

• TEMPO
• Directory of Services
• http//www.eoetraumanetwork.nhs.uk

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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

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Rapid Access Acute Rehabilitation Unit (J2 Ward
in Addenbrookes)

• 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

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Rapid Access Acute Rehabilitation Unit (J2 Ward
in Addenbrookes)

• 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

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Rapid Access Acute Rehabilitation Unit (J2 Ward
in Addenbrookes)

• 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

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RAAR Pathways for Trauma Patients
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Responsibilities of Trauma Units

• Patient flow agreement
• On-going rehabilitation and re-enablement
• Delivering the rehabilitation prescription
• Clinical governance across the network

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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)

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Rehabilitation PrescriptionBiggest Achievement
Paper version
Web based version
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Rehabilitation Prescription Protocols
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Rehabilitation prescription implementation
Live 26/6/13
n526
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One Year of Trauma Network

• October 2012 to October 2013
• Total trauma patients via MTC 729
• Total trauma patients admitted to RAAR 253 (34)

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Type of Injuries (n-729)
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Discharge destinations from MTCn729
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RAAR Discharge Destinationn253
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RAAR Discharge Destination N253
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
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RAAR Repatriations n52
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Repatriation wait in weeks for Level 1 Rehab Unit
Oct 12 to Oct 13
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RAAR Length of Stay

• Minimum 1 day
• Maximum 99 days
• Mean LOS 17.84 days
• 85 discharged within 30 days.

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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

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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

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Aspirations

• Outcome data at one year follow up
• Publish audit and define research question

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Thank You
Fahim.anwar_at_addenbrookes.nhs.uk