Rehabilitation System Standards

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1 TRAUMA DISTINCTION Standards Protocols Performance Indicators Excellence and Innovation Program Overview Rehabilitation System Standards Trauma Distinction recognizes trauma systems that demonstrate clinical excellence and an outstanding commitment to leadership in trauma care. It offers rigorous and highly specialized standards of excellence, in-depth performance indicators and protocols, and an on-site visit by expert evaluators with extensive practical experience in trauma. The program includes an on-site visit every two years. Key components of the program include: Standards: Distinction standards are based on the latest research and evidence related to excellence in trauma care. The trauma standards closely align with the Trauma Association of Canada (TAC) Trauma System Accreditation Guidelines. Protocols: Distinction includes the use of evidence-based protocols to promote a consistent approach to care and increase effectiveness and efficiency. Indicators: A key component of the Distinction program is the requirement to submit data on a regular basis and meet performance thresholds on a core set of performance indicators. Excellence and Innovation: Distinction clients must demonstrate implementation of a project or initiative that aligns with best practice guidelines, utilizes the latest knowledge, and integrates evidence to enhance the quality of care.

2 Standards Overview The Trauma Distinction program includes three sets of standards for trauma services developed in collaboration with the Trauma Association of Canada (TAC): 1-Trauma System, 2-Acute Trauma Services and 3-Rehabilitation System standards. The Rehabilitation System standards focus on how rehabilitation services are integrated within the trauma system to maximise the recovery of trauma patients. The Trauma Distinction program promotes a coordinated strategy for rehabilitation services at the system level where rehabilitation should start early within the trauma centre and continue once the trauma patient is transferred to a rehabilitation centre/unit or discharged home. Accreditation Canada s Rehabilitation System standards are divided into the following subsections: Providing Integrated Rehabilitation Services Evaluating the Quality of Rehabilitation Services Page -2- Pilot Version (July )

3 Standards Structure A set of standards is divided into sections that address different aspects of delivering safe and quality services. Each section consists of related standards, criteria, and guidelines. 1.0 The standard. A goal statement under which associated criteria are grouped. 1.1 The criterion. A measurable element that defines what is required to achieve the standard. Evaluators rate each criterion during the on-site survey. Criterion Types: High Priority: Foundational requirements for delivering safe and quality services. Protocol: Essential protocols that an organization must have in place to promote a consistent approach to care and increase effectiveness and efficiency. Indicator: Criteria linked to the requirement to submit data on a regular basis and meet performance thresholds on a core set of performance indicators. Excellence and Innovation: Criteria linked to the requirement of having a project or initiative that aligns with best practice guidelines, utilizes the latest knowledge, and integrates evidence to enhance the quality of care. Guidelines: Some criteria include guidelines that provide additional information and/or suggestions on how to comply with the criterion. Page -3- Pilot Version (July )

4 Glossary Injury: Injuries are normally classified as intentional or unintentional. Intentional injuries are self-inflicted or inflicted by another person such as suicide/self-harm, violence and abuse. Examples of unintentional injuries include vehicle collisions, falls, drowning and unintentional poisoning. Partner: An organization or person who works with another organization to address a specific issue by sharing information and/or resources. Protocols: Protocols ensure that services are delivered in a consistent manner based on best practices in the field. They can be in the form of guidelines, algorithms or checklists. Rehabilitation: The objective of rehabilitation is to maximise the recovery of trauma patients. Rehabilitation may take place in a variety of settings including a specialized rehabilitation center, an integrated trauma center providing both acute and inpatient rehabilitation services, an outpatient rehabilitation clinic, or a community-based program. Resources: Refers to human, financial and/or informational resources needed to support a project or initiative. Timely/Regularly: The trauma system defines what "timely" and "regularly" mean and adheres to that schedule. Trauma Centre: A centre designated and supported by the appropriate health authority to provide services to injured patients. TAC has defined seven levels of care for trauma services ranging from Level I to V, and Pediatric I and II. All hospitals across the different levels of care are critical to the successful functioning of the trauma system as a whole. Levels I and II refer to hospitals with a primary role in providing care for major trauma. Levels III, IV and V provide essential trauma care until the patient can be transferred to a Level I or II trauma center as appropriate. Trauma System: A pre-planned, organized, and coordinated injury control effort in a defined geographic area (e.g. province or region) that is led by a governmental agency. The configuration of the trauma system will depend on the size of the population and jurisdiction. For example, regional trauma systems are normally based on a population of 1 to 2 million people and consolidate the major trauma cases into one or two major trauma centres (i.e. Level I or II) while distributing the larger volume of less severely injured patients across many hospitals (i.e. Level III, IV or V). Larger provinces may need several regional trauma systems coordinated by a common provincial trauma plan. Page -4- Pilot Version (July )

5 Accreditation Canada Standards Providing Integrated Rehabilitation Services 1.0 The trauma system evaluates the availability of rehabilitation services and works with partners to address gaps for trauma patients. 1.1 The trauma system has access to specialized and integrated rehabilitation programs for burn, head, spinal, and musculoskeletal injuries. Criterion Type: High and Indicator (Rate of Head Injury Referral - Optional) Guidelines: Rehabilitation services are tailored to the trauma patient s loss of function or disability. The trauma system evaluates the availability of rehabilitation services and works with partners to address gaps for trauma patients. Access is provided within the trauma system s jurisdiction and/or through inter-provincial/territorial agreements. 1.2 The trauma system has access to specialized rehabilitation programs for pediatric, adult, and geriatric patients. Guidelines: Access is provided within the trauma system s jurisdiction and/or through inter-provincial/territorial agreements. Trauma Association of Canada Standards Section IV - A & C. Provincial/Regional Trauma Systems Rehabilitation programs for burns, head injury, amputation (prosthetic fitting), pediatric, geriatric, spinal cord injury (B) Traumatic brain injury (TBI) rehab program integrated with inpatient services and continuing to outpatient services (B) TBI consultation available for all patients in the region (B) Rapid expedient consultation with Physiatrist for major trauma patients (B) Rehabilitation programs for burns, head injury, amputation (prosthetic fitting), pediatric, geriatric, spinal cord injury (B) Page -5- Pilot Version (July )

6 Accreditation Canada Standards 1.3 The trauma system has access to rehabilitation services in inpatient, outpatient, home-based, or community settings as required. Guidelines: Rehabilitation services are integrated with inpatient services and continuing to outpatient services. N/a Trauma Association of Canada Standards 1.4 The trauma system has access to dedicated inpatient rehabilitation beds for multiple trauma patients. 2.0 The trauma system collaborates with rehabilitation services to provide safe and high quality care for trauma patients. 2.1 The trauma system has rehabilitation protocols based on current research and best practice information. Criterion Type: Protocol (Rehabilitation) Guidelines: Protocols are one of the four components of the Trauma Distinction program to ensure that rehabilitation services are delivered in a consistent manner across the trauma system. The Trauma Distinction program identifies a framework for protocols across the trauma care continuum that are supported by nationally and/or internationally recognized guidelines. Dedicated provincial inpatient beds for multisystem trauma patients (B) Section IV - A & C. Provincial/Regional Trauma Systems, and B. Provincial and Quaternary Trauma Services Province/Region-wide trauma performance improvement and patient safety (PIPS) program including Standardized Practice Guidelines for Trauma Care (A&C) Protocols for rehabilitation services are tailored to the patient s age group and loss of function or disability, and are standardized across the trauma system. Examples include protocols for burn, and head, spinal and musculoskeletal injuries. Page -6- Pilot Version (July )

7 Accreditation Canada Standards 2.2 The trauma system has protocols for assessing patient outcomes for rehabilitation services. Criterion Type: Indicator (Evaluation of Patient Functional Status - Optional) Trauma Association of Canada Standards Integration of rehabilitation with assessment of outcomes e.g. FIM, SF-36, PTSD, alcohol use (B) Guidelines: Patient outcomes can be assessed using a variety of tools such as the Functional Independence Measure (FIM) and SF-36 Health Survey. Evaluating the Quality of Rehabilitation Services 3.0 The trauma system collaborates with rehabilitation services to evaluate the quality of rehabilitation services for trauma patients. 3.1 The trauma system s Performance Improvement and Patient Safety (PIPS) program evaluates how rehabilitation services are delivered within the system. Section IV - A and C: Provincial/Regional Trauma Systems N/a Criterion Type: High Guidelines: The trauma system is responsible for monitoring its own performance and the performance of the subcomponents within the system. The PIPS program is an organized and comprehensive review of trauma care and patient outcomes. Evaluation results can be used to improve the quality of rehabilitation services to the population served, to drive research, and contribute to system integration initiatives. Page -7- Pilot Version (July )

8 Accreditation Canada Standards 3.2 The trauma system uses the rehabilitation information system to generate regular reports about performance, patient outcomes and adherence to rehabilitation protocols. Trauma Association of Canada Standards Criterion Type: Indicator (Wait Time for Rehabilitation Services) Guidelines: Rehabilitation services are provided with information about their use of rehabilitation protocols. The trauma system may summarize the information by injury and/or population type. 3.3 The trauma system monitors performance indicators for rehabilitation services. N/a Criterion Type: High and Indicator (Change in Functional Status Optional) Guidelines: Monitoring performance indicators is one of the four components of the Trauma Distinction program to help demonstrate excellence in delivery of trauma care. Indicator results are used to identify strengths and areas for improvement as part of the PIPS program. These include a set of core performance indicators that trauma systems have to report on and meet thresholds. Trauma systems are also expected to report on additional performance indicators from a list of optional indicators. 3.4 The trauma system uses evaluation results to identify strengths, share best practices and make improvements to rehabilitation services within the system. Guidelines: The trauma system encourages and supports sharing quality improvement activities and best practices within the system. Excellence and innovation is one of the four components of the Distinction program that provides trauma systems with the opportunity to highlight outstanding achievements in their field. Trauma systems are asked to submit one excellence and innovation project or initiative that has enhanced the quality of trauma services. Page -8- Pilot Version (July )

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