Kevin Jackson

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NATIONAL REHABILITATION HOSPITAL DUN LAOGHAIRE
Kevin Jackson
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REHABILITATION EXISTING NATIONAL REHABILIATION
HOSPITAL RESEARCH NEW NATIONAL REHABILITATION
HOSPITAL
NATIONAL REHABILITATION HOSPITAL DUN LAOGHAIRE
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The NATIONAL REHABILITATION HOSPITAL
Founded in 1961 by the Sisters of Mercy Publicly
funded In-patient capacity 121
The NRH provides comprehensive
multi-disciplinary inpatient and outpatient
services to patients from throughout Ireland, who
have acquired a physical or cognitive disability
as a result of an accident, illness or Injury and
require specialist medical rehabilitation.
Dr Aine Carroll, NRH
4
The NATIONAL REHABILITATION HOSPITAL

• The NRH focus is to provide personalised
  treatment plans dedicated to returning patients
  to the highest level of independence possible
  following their injury.
• The Programmes are tailored to meet the
  individual needs of adult and paediatric patients
  in the following areas of specialty
• Brain Injury (including traumatic and
  non-traumatic brain injury, Stroke, and other
  neurological conditions)
• Spinal Cord System of Care (including traumatic
  and non-traumatic spinal cord injury)
• Prosthetic, Orthotic and Limb Absence
  Rehabilitation (POLAR)
• Paediatric-Family Centred Rehabilitation

Dr Aine Carroll, NRH
5
PATIENT TYPES
BRAIN INJURY TRAUMATIC
BRAIN INJURY MIXED NEURO/MS
BRAIN INJURY STROKE

• SOME COGNITIVE
• IMPAIRMENT
• HIGH RISKS OF ACCIDENTS
• LOSS OF PHYSICAL ABILITY
• (LEFT / RIGHT)
• RIGHT SIDED BRAIN DAMAGE
• LEFT SIDED BRAIN DAMAGE
• POSSIBLE COMMUNICATION PROBLEMS
• POSSIBLE COGNITIVE PROBLEMS
• MINIMISE DISTRACTION
• WHEELCHAIR STORAGE
• BATHROOM ERGONOMICS
• DISABLED USER

• PHYSICAL INCIDENT
• POSSIBILITY OF CHALLENGING BEHAVIOUR
• IMPAIRED COGNITION
• DISORIENTATION
• SHOUTER
• PACER
• POOR INSIGHT TO THEIR OWN
• CONDITION
• LEFT/RIGHT SIDED BRAIN
• DAMAGE MIGHT CAUSE
• COMMUNICATION/COCNITIVE
• PROBLEMS
• MINIMISE DISTRACTION
• SECURE ENVIRONMENT
• ONE TO ONE MEETINGS
• ISOLATION
• OBSERVATION
• CLOSED UNIT

• NEURO ILLNESS / DISEASE
• IMPAIRED COGNITION
• DISORIENTATION
• HIGH DEPENDENCY TO
• LOW DEPENDENCY
• MINIMISE DISTRACTION
• SECURE ENVIRONMENT
• OBSERVATION
• RECREATION

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PATIENT TYPES
SPINAL CORD INJURY (SCI)
AMPUTEE / GENERAL REHAB

• QUADRIPLEGICS
• PARAPLEGICS
• HIGH DEPENDENCY UNIT
• SUPPORT EQUIPMENT
• PSYCHOLOGICAL ADJUSTMENT
• SOME CHALLENGING BEHAVIOR
• SORE SKIN
• BOWEL CARE PRIVACY/ COMFORT
• SHOWER / BATHROOM ERGONOMICS
• PATIENT CONTROLLED ENVIRONMENT
• WHEELCHAIR STORAGE
• RECREATION / LEISURE TIME
• EXTERNAL SPACE TO ACCOMMODATE PATIENT BED

• MEDICALLY STABLE
• SOME CHALLENGING BEHAVIOR (LESS EXTREME)
• MAINLY ELDERLY PATIENTS
• RE-EDUCATION
• PSYCHOLOGICAL ADJUSTMENT
• WHEELCHAIR STORAGE CLOSE TO PATIENT
• BATHROOM ERGONOMICS
• RECREATION / LEISURE TIME
• INTERNAL EXTERNAL TRAINING AREA

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PATIENT TYPES
PAEDIATRIC
PRE DISCHARGE

• ALL PATIENT TYPES
• PREDOMINANTLY BRAIN INJURY PATIENTS
• AGE MIX ( 0 -18 YEARS)
• CHILD ORIENTATED ENVIRONMENT
• SEPARATE ADOLESCENT CHILD AREA
• MINIMISE DISTRACTION (SOUND) IN SOME AREAS
• FAMILY ACCOMMODATION
• SEPARATE OUTDOOR PLAY AREA/S
• EXTERNAL ACCESS

• TRANSITION FROM HOSPITAL TO HOME
• MOST PATIENT TYPES
• SUPPORT ONLY WHEN REQUIRED
• MEDICALLY STABLE
• INTERNAL EXTERNAL TRAINING AREA
• RECREATION / LEISURE TIME
• KITCHEN FACILITY

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PATIENT CYCLE
Community
Home
Episode
Acute Phase
Rehabilitation Phase
Home
Cycle
AVERAGE STAY 6 MONTHS RETURN AS OUTPATIENTS EVERY
6 MONTHS
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PATIENT SUPPORT
Educational
Family
Adult
Psychological
Social
PATIENT
Child
Clinical
Relevant Experience Base
General Clinical Educational
Paediatric Rehabilitation
Disability
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APPROACH TO A REHABILITATION HOSPITAL
Able Bodied
Disabled
Less Severely Disabled
Severely Disabled
Universal Design Equal Status Act 2000
Outside Normal Access Limits
Disability Exclusion
Universal Design Equal Status Act 2000
Physical Accessibility
Inclusion
Rehabilitation Process
Motivation Therapy/Education Accommodation Continu
ation
Rehabilitation
Inclusion
Competence
Rehabilitation Hospital Access Objective
Inclusion Zone
Normal Zone
Exclusion Zone
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NRH
BRIEF
THERAPY PHYSIOTHERAPY OCCUPATIONAL
THERAPY SPEECH AND LANGUAGE MEDICAL SOCIAL
WORKERS CLINICAL NUTRICIAN OUTPATIENTS HYDROTHE
RAPY SPORTS
235 BEDS 50 TO BE SINGLE ROOMS 2 x 40 BED
BRAIN INJURY 1 x 40 BED SPINAL CORD 1 x 20 BED
AMPUTEE / GENERAL 1 x 20 BED PRE DISCHARGE 2 x
20 BED HIGH DEPENDENCY UNITS 1 x 15 BED HIGHER
DEPENDENCY UNIT 1 x 20 BED PAEDIATRIC 10
CHILD10 ADOLESCENT CLINICAL SUPPORT RADIOLOGY
GENRAL X-RAY, CT, MRI, ULTRA SOUND PROSTHETICS
ORTHOTICS PATHOLOGY, PHARMACY,
CSSD ANCILLARY ADMINISTRATION, CATERING,
TECHNICAL SERVICES, IT, HOUSEKEEPING, WASTE CAR
PARKING SPECIAL SCHOOL
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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EXISTING NRH
SITE PLAN
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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EXISTING NRH
VIEWS OF DUBLIN BAY
SITE PLAN
VIEWS OF DUBLIN MOUNTAINS
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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EXISTING NRH
SUN PATH
SITE PLAN
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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EXISTING NRH
LEVEL 0
CONVENT
ANCILLARY
ADMIN.
ADMIN.
DINING
HYDRO THERAPY
PHYSIO THERAPY
MEDICAL
DAY
PROSTHETICS
PROSTHETICS
SCHOOL
OCCUPATIONALTHERAPY
OPD
RTU
SPORTS HALL
SPEECH
ADMIN.
PATIENT MOVEMENT
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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EXISTING NRH
ALL FLOORS
LEVEL 3 - WARDS
LEVEL 2 - WARDS
LEVEL 1 - WARDS
LEVEL 0 - THERAPY
PATIENT MOVEMENT
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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REHABILITATION DESIGN
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CONSULTATION
CLIENT PATIENTS STAFF HOSPITAL PLANNING
TEAM DEPARTMENT HEADS MEDICAL COUNCIL
MANAGEMENT TEAM NRH BOARD HSE
ADVISORS
ARCHITECT DESIGN TEAM
CORE GROUP PROJECT MANAGER
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CONSULTATION PATIENTS STA
FF HOSPITAL PLANNING TEAM DEPARTMENT
HEADS MEDICAL COUNCIL MANAGEMENT TEAM NRH
BOARD HSE ADVISORS
PRESENTATIONS
ARCHITECT DESIGN TEAM
CORE GROUP PROJECT MANAGER
MEETINGS
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RESEARCH
SWISS PARAPLEGIC CENTRE NOTTWIL, SWITZERLAND
Spinal Injury Rehab. Center Beds 150 Average
stay 6 months -1 year 2 bed rooms only (32.2
sqm) En Suite All bedrooms are adjacent to
common balcony One nurse station for 30
patients Nurse station enclosed
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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RESEARCH
REHABILITATION CLINIC, SION, SWITZERLAND
Rehabilitation Clinic for Brain Injury and S.C.I.
connected to the existing Regional
Hospital Area 27 400 sqm Beds 180no. All
bedrooms for 2 patients, all bedrooms with small
balcony Communal balcony at end of ward corridor
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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RESEARCH
REHABILITATION HOSPITAL, BASEL, SWITZERLAND
Rehabilitation Clinic for Brain Injury
Patients Beds 80no. Average stay 18
months Single (26.7sqm) and 2 bed rooms
(34.7sqm) En Suite access onto common
balcony Each ward has enclosed pacing route
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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RESEARCH
INSTITUT SAINT-PIERRE, PALAVAS-LES-FLOS, FRANCE
Paediatric Rehabilitation Clinic Beds 90 All
bedrooms with access onto large common
balconies Patient bedrooms are orientated
towards each other (U-shape) allow patients to
watch other activities School in separate
building
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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RESEARCH
SYNAPSIA REHABILITATION CENTER, HELSINKI, FINLAND
Rehabilitation Centre for S.C.I, Brain Injury,
Stroke Patients Outpatients Beds approx.
75no. Average stay 2weeks 4months Single
bed rooms only (16.5 sqm) Communal balconies
with glass enclosure Patient types close to NRH
but not as severe Ward layout small sub-groups
of rooms arranged around living area
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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RESEARCH
UK FACILITIES VISITED AND EXAMINED
ASPIRE - NATIONAL TRAINING CENTRE, STANMORE,
UK sport facilities at the royal national
orthopaedic hospital FRENCHAY - BRAIN INJURY
REHABILITATION CENTER, BRISTOL, UK 20 private
rooms 5 bed intensive nursing bay REGIONAL
NEUROLOGICAL REHAB UNIT AT HOMERTON UNIVERSITY
HOSPITAL, HACKNEY, UK rehabilitation unit for
brain injury / 24 beds QUEEN SQUARE BRAIN
INJURY UNIT AT NATIONAL HOSPITAL OF NEUROLOGY,
LONDON, UK rehabilitation assessment unit / max.
stay 6 weeks / 12 beds CLAYPONDS HOSPITAL
NEUROLOGICAL REHABILITATION HOSPITAL, EALING,
LONDON, UK elderly stroke patients predominant /
78 beds incl. 26 stroke beds BATTLE HOSPITAL
REHABILITATION HOSPITAL READING,
UK rehabilitation hospital with neurological unit
/ 78 beds incl. 28 neuro beds
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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REHABILITATION CONCEPT DEVELOPMENT
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CONCEPT
PATIENT TYPES AND PRIMARY DEPARTMENTAL ADJACENCY
MATRIX
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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EXISTING NRH
ALL FLOORS
LEVEL 3 - WARDS
LEVEL 2 - WARDS
LEVEL 1 - WARDS
LEVEL 0 - THERAPY
PATIENT MOVEMENT
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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MULTIDISCIPLIANRY PATIENT CENTERED THERAPY SERVICE
SL
Physio
OT
MSWP
B.I.
SL
Physio
SL

• PATIENT MOBILITY
• EFFICIENCY IN USE OF TIME
• DEPARTMENTAL COHERANCE
• COMMON RESOURCES

OT
MSWP
Spinal
Spinal
INTEGRAL CLINICAL SERVICE
SL
Physio
MSWP
OT
Rehab Prosth
SL
Physio
SL
OT
MSWP
Paediatrics
Spinal
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CONCEPT
PRIMARY ADJACENCIES
THERAPY (WORK) REST/ SLEEP (HOME)
CATERING

BRAIN INJURY 40 BEDS
S L CLIN. NUTRITION CLIN. PSYCHOL. MED. SOCI
AL WORK
SHARED CLINICAL SERVICES

BRAIN INJURY 40 BEDS
PHYSIO THERAPY
O.T.
SPINAL INJURY 40 BEDS


OUTPATIENT CLINICAL SERVICE PROSTHETIC ORTHTIC
DEPT.
PROSTHETIC GENERAL REHAB 20 BEDS
PRE DISCHARGE 20 BEDS
OT FLAT
SPORTS HALL HYDROTHERAPY POOL
EXTERNAL LINK UPPER GROUND FLOOR
BRAIN INJURY HSU 15 BEDS
PAEDIATRIC 20 BEDS
BRAIN INJURY 20 BEDS
BRAIN INJURY HSU 20 BEDS
THERAPY
THERAPY
EXTERNAL LINK LOWER GROUND FLOOR
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
3D VIEW
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
3D VIEW
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
MASTERPLAN
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
Master Plan Future Vision
MASTERPLAN
RESIDENTIAL ZONE
ZONE FOR NEW NRH
HOSPITAL PARKING ZONE
SPORTS FACILITIES ZONE
RESIDENTIAL ZONE
ANCILLARY HOSPITAL ZONE
PROSTHETIC MANUFACTURING ZONE
OTHER HEALTH CARE FACILITIES ZONE
PROPOSED SITE ZONING STRATEGY
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PROJECT
GROUND FLOOR
OPD
CONCOURSE
PROSTETHICS
RADIOLOGY
CONCOURSE
PRE-DISCHARGE WARD
PROSTHETIC GENERAL REHAB WARD
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
TYPICAL WARD FLOOR - SECOND FLOOR
ANCILLARY SERVICES
PT
OT
PSYCH. / SPEECH / MSW
BRAIN INJURY WARD
BRAIN INJURY WARD
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
TYPICAL WARD FLOOR - SECOND FLOOR
THERAPY BLOCK WARD BLOCK
SLT / MSW / PSYCHO THERAPY
OCC. THERAPY
PHYSIO THERAPY
ANCILLARY SERVICES
MEDICAL SERVICES
BI WARD 20 BEDS
BI WARD 20 BEDS
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
TYPICAL WARD FLOOR - SECOND FLOOR
MULTIDISCIPLINARY THERAPY SERVICE
SLT / MSW / PSYCHO THERAPY
OCC. THERAPY
PHYSIO THERAPY
ANCILLARY SERVICES
MEDICAL SERVICES
BI WARD 20 BEDS
BI WARD 20 BEDS
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
TYPICAL WARD FLOOR - SECOND FLOOR
WORK PATIENT ROUTINE REST
SLT / MSW / PSYCHO THERAPY
OCC. THERAPY
PHYSIO THERAPY
ANCILLARY SERVICES
MEDICAL SERVICES
BI WARD 20 BEDS
BI WARD 20 BEDS
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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RESEARCH
BEDROOM SIZE EXAMINATION - PROTOTYPE ROOMS IN THE
EXISTING NRH
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
TYPICAL SINGLE BED ROOM LAYOUTS
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
BALCONIES - SAFETY , SECURITY PRIVACY
SECTION ELEVATION
PLAN
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
FLOOR PLAN
LEVEL -1
ANCILLARY SERVICES
SPORTS FITNESS
PAEDIATRIC WARD 20 BED
BRAIN INJURY WARD 20 BED
BRAIN INJURY WARD HDU 20 BED
BRAIN INJURY WARD 15 BED
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PROJECT
ELEVATIONS / SECTION
SOUTH WEST ELEVATION

WARD BLOCK
NORTH - EAST ELEVATION
THERAPY BLOCK

CONCOURSE
CROSS SECTION THERAPY
BLOCK LANDSCAPE WARD
BLOCK
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
3D VIEW
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
3D VIEW
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
3D VIEW
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
3D VIEW
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
3D VIEW
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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PROJECT
3D VIEW
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE
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The NATIONAL REHABILITATION HOSPITAL
Dr Aine Carroll, NRH
52
The NATIONAL REHABILITATION HOSPITAL

• Total inpatients admitted (Oct - Dec)
• Brain Injury 28
• Spinal Cord Injury 21
• Stroke 19
• Prosthetics 19
• Paediatric Patients 12
• Other Neurological 1

Dr Aine Carroll, NRH
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The NATIONAL REHABILITATION HOSPITAL
Dr Aine Carroll, NRH
54
The NATIONAL REHABILIATION HOSPITAL

• Patient Discharge Destination
• 80 discharged home
• 20 not discharged home
• 10 back to acute hospital for non-medical
  reasons
• 10 residential/nursing care
• The number being transferred back to acute
  hospitals is likely to increase to 20 in 2009

Dr Aine Carroll, NRH
55
The NATIONAL REHABILIATION HOSPITAL

• IMPACT OF NEW HOSPITAL
• More responsive to need
• Reduced waiting list
• Reduced length of stay in acute hospital
• Reduced Complications
• Reduced inappropriate readmissions to acute
  hospitals
• Reduced length of stay at NRH
• Centre of Excellence (CARF, International
  standards of Rehabilitation)
• Critical mass of expertise to allow direction of
  regional development
• Managed clinical networks

Dr Aine Carroll, NRH
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PROJECT
3D VIEW
NATIONAL REHABILITATION HOSPITAL, DUN LAOGHAIRE