Rehabilitation Work Stream

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Rehabilitation Work Stream Major Trauma
Project Beth Worrall
December 2008
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The need for a trauma system

• Significant deficiencies in the care and
  treatment of patients following major trauma
• Evidence that severe trauma should be dealt with
  in a few specialised centres
• UK is unusual amongst similar nations in not
  having a system of regionalised trauma centres
• Schedule for implementation 2010

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The proposed trauma system
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Benefits of a trauma system

• Patients managed in the most appropriate facility
• Culture of collaboration between organisations
• Consistent standards across the system
• Clear leadership and responsibility within each
  network and across the system
• Development of skills and knowledge

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Healthcare for London Major Trauma Project

• Develop optimal care pathway
• Definitive proposal for configuration of Londons
  trauma system
• Implement plan and agreed trauma pathways
  (subject to consultation process)
• Focus on most severely injured injury severity
  score of 16 or more

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Objectives of rehabilitation work stream

• Establish the current state model for major
  trauma rehabilitation
• Identify the main problems with the current
  state
• Establishing volume requirements for
  rehabilitation following major trauma
• Make suggestions for development required to
  achieve improvement

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Major Trauma Rehabilitation Pathway Current
State
Voluntary other services
Specialist in-patient rehabilitation
Local authority home support, equipment or
adaptations
Hospital
Major trauma
Home
Local in-patient rehabilitation
Community Rehab
Local acute hospital
Local Mental Health Unit
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Current state problems

• Coordination and navigation through the system
• Cross boundary working and discharge facilitation
• Access to equipment and adaptations
• Delay in accessing specialist rehabilitation
• Housing Issues
• Immigration Status
• Data management
• Inconsistencies in service provision

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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

• Service delivery models and structure
• Workforce
• Information
• Capacity

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Service delivery models and structure

• Acute rehabilitation facilities
• Common standards
• Governance opportunities
• Shared care models

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Workforce

• Use US workforce model as foundation for
  workforce structure development
• Workforce development plan
• Rotational opportunities
• Case manager role development

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Information management and capacity review

• Data management system
• Outcome measurement
• International classification of functioning,
  disability and health (ICF)
• Development of directory of services
• Accurate capacity review dependent on data
  management

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What next..?

• Allied Health CPD framework development
• Integrating health and social care work stream
• Consultation followed by network implementation
• Network development
• System development