Rehabilitation Following Major Trauma in the North West

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1 Rehabilitation Following Major Trauma in the North West Acute / early rehabilitation Community based rehabilitation, including vocational aspects

2 Acute / Early Rehabilitation Following Major Trauma Dr Krystyna Walton Consultant in Neurorehabilitation Salford Royal NHS Foundation Trust

3 Causes of Major Trauma Road traffic accidents Accidents at work Sports, including extreme sports Falls Blasts, stabbings etc Legs most commonly affected Young adult males predominate

4 Acute / Early Rehabilitation Following Major Trauma 1. Why are we doing this? 2. When will rehabilitation start? 3. How will rehabilitation & re-ablement be delivered in the North West? 4. How should we do it?

5 Continuum of Care after Major Trauma Traditional Pathway Pre-hospital care Acute care Ongoing care Rehabilitation

6 Head Injury Pathways Emergency / acute management NeuroICU / NeuroHDU Neurosurgical ward DGH bed. Medical (if you re lucky!) could be any specialty Orthopaedic Surgical A & E ENT Mental health Rehabilitation

7 Common pathways to head injury rehabilitation Transfer from Neuroscience bed to DGH Expertise lacking Clinical pathway via unconventional routes Delays Prolonged inpatient episodes Significant co-morbidities & complications Extremely stressful for families Lack of appropriate information & support

8 Acquired Brain Injury 2 22 year old male, involved in RTA ICU care in general ITU Lots of intercurrent problems seizures, dysautonomia, strong bite reflex Tracheostomy, PEG feeding Assumption that outcome would be poor Treating team looking at NHS Continuing Care

9 Acquired Brain Injury 2 PCT advised brain injury rehabilitation Development of heterotopic ossification around hips had not been recognised On transfer to neurorehabilitation unit, severe deformities around hips Failure to recognise potential for recovery in acute setting Good cognitive & physical neurological recovery No possibility of weight bearing or walking

10 Rehabilitation Following Major Trauma What we have now in the North West Pathways variable for Neurorehabilitation Acute Neurorehabilitation, variable provision

11 Greater Manchester Acute Neurorehabilitation Pathway What we have now Established pathways for Neurorehabilitation Acute Neurorehabilitation 20 dedicated beds Patient flow issues a major problem for a number of reasons

12 Rehabilitation Following Major Trauma What we have now in the North West Pathways variable for Neurorehabilitation Acute Neurorehabilitation, variable provision Patient flow issues a major problem

13 Rehabilitation Following Major Trauma What we have now in the North West Pathways variable for Neurorehabilitation Acute Neurorehabilitation, variable provision Patient flow issues a major problem Major trauma rehabilitation With neurological problems Without neurological problems????????????

14 Continuum of Care after Major Trauma Pre-hospital care Acute care Acute Rehabilitation Ongoing care Acute Rehabilitation Post-acute Rehabilitation The Mode of Delivery of Rehabilitation & Re-ablement will differ in the 5 Major Trauma Systems in the North West

15 When Must Rehabilitation Start? In Major Trauma Centre Hospitals Within 24 hours of admission On Critical Care & High Dependency Units

16 Principles of Acute Rehabilitation Anticipation & prevention of complications infections Recognition, minimisation & management of consequences of major trauma Co-ordination ordination of ongoing rehabilitation

17 Standards for Major Trauma Rehabilitation Major Trauma Centre Hospitals 1. Rehabilitation planning will start in the 1 st 24 hours of MTC care 2. A Rehabilitation Prescription will be initiated within 48 hours of MTC care 3. Every patient will leave acute care with a Rehabilitation Prescription

18 The Rehabilitation Prescription First RP initiated within 48 hours of admission to MTC hospital Intended to be shared with the patient MDT document Can be signed off by Rehabilitation Medicine doctor at ST3 or above or band 7 nurse/ahp RP on transfer or discharge from acute care

19 Service models 1. Trauma 2. Head injury

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22 Responsibilities of Non-MTC Hospitals Ongoing rehabilitation & re-ablement Rehabilitation assessment within hrs Delivering the Rehabilitation Prescription Rapid response for transfers from MTC hospitals Involvement in governance across the Major Trauma Network

23 Stepped Care Model for Long Term Conditions adopted for Major Trauma Rehabilitation Specialist Care Transitional Care approach Person who has sustained Multiple trauma Enhanced Care Supported Self Management Transitional care is a planned and managed process where a person with long term conditions is actively and collaboratively managed as they move between care settings or teams.. NHS North West Adult and Elderly CPG, 2010 Independence & Autonomy Joining Up Care For People With Long Term Conditions NHS North West 2010

24 Transitional care is a planned and managed process where a person with long term conditions is actively and collaboratively managed as they move between care settings or teams.. NHS North West Adult and Elderly CPG, 2010

25 Rehab after hospital discharge Long term outcomes are what matters Community and/or outpatient rehab services Do we know where the gaps are? Who has commissioning responsibility? What funding mechanisms are available? Who is monitoring? Inter-sector network of services, where non- health and third sector have vital roles to foster societal reintegration and real world outcomes

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