1. Rehabilitation Prescriptions- Working to improve outcomes for Children affected by Major Trauma
Aimee White
Bristol Royal Hospital for Children Major Trauma Rehabilitation Coordinator

2. What were the issues? UK 20% higher mortality rate Lack of volume
Lack of Consultant ownership
Lack of communication
Unclear rehab plan
“Dropped off a cliff”

3. Survive to Thrive

4. April 2012 England opened Major Trauma Centres
810,OOO children< 16yrs
Greatest shake in the last 50 yrs
US, Australia and the army
One of 5 stand alone children's major trauma centres-
2012 launch of Major Trauma networks
2014 Bristol Royal Hospital for Children went live as the Major Trauma Centre for Severn and Peninsula Network MT pts (E115= I=41 N=22) 2015 (E 141= I=67 N=21) 2016 (E=22 I=10 N=2)
2014
200

5. What is a Major Trauma Patient?
BRAIN or SKULL Injury
Fractured FEMUR or PELVIS
Internal THORAX injury
ASPHYXIA or
DROWNING
SPINE
Cord Injury, fracture or dislocation
OPEN LIMB
Fracture
Internal ABDOMEN Injury
FROSTBITE or
ELECTRIC SHOCK
NERVE or VESSEL injury
BILATERAL closed LIMB
Fracture
AMPUTATION or
MAJOR DEGLOVING
INHALATION
Guided by TARN

6. BPT Key performance indicator (KPI) 96.3%
Above the national mean of 92.3 %

7. Rehabilitation PrescriptionsED
surgery
Rehabilitation

8. Bespoke or Production Line?

9. Multidisciplinary

10. Clear Assessment of Holistic Needs

11. Clear Discharge needs

12. Outcome Major Trauma centres improved mortality rate 40 %
CSP more volume
Identification via Rehab Prescription
MT Coordinators improved communication
Rehab Prescription empowers parents

13. Thank you!

15. Medway
Spread Sheet

16. Rehabilitation Prescriptions- The Uptake
Aimee White
Bristol Royal Hospital for Children Major Trauma Rehabilitation Coordinator

17. Multidisciplinary

18. Link to Medway

19. Dash Board Key performance indicator (KPI) 96.3%
Above the national mean of 92.3 %

20. Eligible Patients for Rehab Prescription
TARN
Hospital stay> 72 hour
To get any Tariff need to be completed
May 2014-to date 290

21. Bristol Royal Hospital for Children
Neurosciences Ward

22. Background CSP complete in May 2014
All major specialities under one roof
Launch of Major Trauma Centre
Rehab ward opened

23. What we treat..
Specialist Neurosurgical and Neurosciences treatment and rehabilitation
ABI
TBI
Oncology (Brain)
SDR- on hold
Non organic
Medical

24. The Rehabilitation Unit
8 bedded facility
Requires 2 FQN
Parent led
Promotes independence
Bridge prior to discharge
Group dynamics

25. Focus Group-service users
“Fresh Air”
“Ensuite toilets accessible for wheelchair users”
Doors that save on space
An inspiring space-currently “soleless”
“Somewhere where you can be alone”

26. The Wish List-staff
Existing Bathroom- make it a relaxation space, multi sensory
Toilet in rehab ward- swap sink /toile
Over head tracking 38b
Washing machine/ dryer
Over head tracking
Biometrics software
Ipads (x8)
Rehab shower room, needs finishing detail
Oasis Garden
Nursing station and feature wall- inspiring.
Kitchen
Tilt and space shower chair
Look and Learn system

27. In Summary A

28. Paediatric Major Trauma

29. Benefits To Patients To staff Relax patients- more homely feel
Enable patients to access facilities in a wheelchair

30. Trauma: Who Cares?
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reported:
60% of care was
“less than good practice.”
20 % higher in-hospital mortality rate in England compared to the US.
UNICEF “Injury has now become the leading killer of year olds accounting for almost 40% of deaths in that age group.”
(2007) Trauma: Who Cares?

31. Bristol Royal Hospital for Children
On 7th May 2014 we became the Paediatric Major Trauma Centre for Severn and Peninsula Networks

32. April 2012 England opened Major Trauma Centres
Greatest shake in the last 50 yrs
US, Australia and the army
One of 5 stand alone children's major trauma centres-

33. What is a Major Trauma Patient?
BRAIN or SKULL Injury
Fractured FEMUR or PELVIS
Internal THORAX injury
ASPHYXIA or
DROWNING
SPINE
Cord Injury, fracture or dislocation
OPEN LIMB
Fracture
Internal ABDOMEN Injury
FROSTBITE or
ELECTRIC SHOCK
NERVE or VESSEL injury
BILATERAL closed LIMB
Fracture
AMPUTATION or
MAJOR DEGLOVING
INHALATION
Guided by TARN

34. Weekly MDT Every Wednesday 12.30-13.30
Held in Theatre Seminar Room, Level 4
Discuss full pathway of care with MDT
Discuss pre hospital care and network transfer ED
On going needs on the ward
Rehabilitation needs
Safeguarding and social considerations

37. Major Trauma Co-Ordinators
Ensure under a named Consultant and patient ownership
Ensure Rehabilitation Prescription completed and Tertiary Survey are completed
Consider safeguarding and social Support
Consider psychological needs
Champion care
Link between teams and ensure effective communication
Link into discharge planning and community needs
Education
Familiar contact for parents and child throughout hospital admission
Advocate for Family
Liaison with families in PICU
Delivering news
Rainbow room
Tracking KPI
Hollistic
All pateinst needs
Link across disciplines
Signe post
Follow up

38. Summary. I now know….. That I work in a Major Trauma Centre!
Why we have Major Trauma Centres
What a Major Trauma patient is
Seasonal changes in activity
Injuries sustained
Where and when the Major Trauma MDT meeting is held
Role of a Major Trauma Co-Ordinator
Contact details for further information

39. Useful Contact Details
TTL
Co-Ordinator Bleeps
Aimee 6871
Jenni 6826
Or ext 28488