1. 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 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 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
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