Patient Specific Functional Scale EARLY IN-REACH REHABILITATION FOR TRAUMA PATIENTS AT A MAJOR TRAUMA CENTRE – INITIAL EXPERIENCE Richardson D, Bialkowski S, Dale K, Chen B, Cambell D, Wullschleger M, Boyle T The Rehabilitation Response Team (RRT) is an innovative multidisciplinary service implemented at the Gold Coast University Hospital in March 2016. RRT provides assessment of Rehabilitation referrals and specialist in-reach rehabilitation to patients during acute episodes of care. Model of care Trauma patient overview Data from April 2016- April 2017 Accepted for RRT 43 patients Average age (19-92) 51yrs Gender 38 ♂, 5 ♀ Average initial ISS (Injury Severity Score) 26 Average RRT length of stay 10 days Target population: acute patients at Gold Coast University Hospital Rehabilitation Response Team 11.3 FTE MDT Early assessment In-reach rehabilitation < 2 week program 10 packages available Inpatient Rehabilitation (Gold Coast) (Other district) Discharge (avoidance of inpatient rehabilitation) Return to acute care episode (medically unwell / rehabilitation goals achieved requiring ongoing medical intervention) RRT Assessment Team coordinate direct admission to rehabilitation unit Actual Discharge destination 16% of patients discharged home avoiding inpatient rehabilitation Interventions Shared care between acute trauma and rehabilitation teams. Rehabilitation physician consultation and option to initiate rehabilitation episode of care Co-ordinated behaviour management plan for agitation  Access to rehabilitation gym and specialised equipment  Use of occupational therapy enriched environment 'Lifespace' Management of spasticity and serial casting Cuff deflation and speaking valve trials Dysphagia rehabilitation guided by videofluoroscopy and fibre-optic endoscopic evaluation of swallowing Early communication intervention Case management with complex discharge planning  Use of Tele-recover facilitating communication between rehabilitation units and community services  Functional independence measure (FIM) outcomes in-reach RRT (n= 43) FIM efficiency Average: 1.57 Australian FIM efficiency: Average:1.04* * Note inpatient rehabilitation data de Morten Mobility Index scores DEMMI (n= 43) Admission Average: 28.85 Discharge Average: 42.09 Patient Specific Functional Scale PSFS (n= 43) Admission Average: 4.3 / 10 Discharge Average: 7.0 /10 Challenges RRT service delivery Medically unstable patients Education of RRT therapists Acute patients in subacute environment -Timetabling therapy -Transit time to and from gym -Sourcing appropriate therapy equipment -Limited improvement in patients undertaking ‘trials’ of RRT -Patients with low motor FIM scores requiring multiple therapists Acute wards Rehabilitation education of acute care services Time constraints of nursing staff Inconsistent staffing level and skill mix of acute ward therapists Key Performance Indicators Early rehabilitation intervention Improve functional outcomes Promote rehabilitation philosophy Increased intensity of therapy Facilitate patient flow – reduce length of stay in acute and rehabilitation Prevent deconditioning Reduce secondary complications Patient flow Out-of-district rehabilitation patients Impact of bed pressure on predetermined rehabilitation pathway Future Directions Formal evaluation of RRT across all specialities Second year comparative project from April 2017-2018 Establish formal guidelines for pharmacological and non-pharmacological management of acute phase agitation in traumatic brain injuries. Acknowledgements: Taylor M, Marconi K, Francis K, Karwaj A, Lyle J