What is rehabilitation?
Rehabilitation involves a team approach to improving the physical, psychological, social and emotional problems that may arise after experiencing injuries due to trauma.The approach used is aimed at helping the patient to get back to their previous life roles whenever possible through regaining independance, increasing activity and enhancing participation in society once more.The key is to optimise recovery through encouraging recovery and healing, and where permanent deficits in bodily function are expected, to guide the patient to compensate for these losses.
Who is involved?
A patient’s rehabilitation will include some or all of the following, and others may also be involved:
• The patient
• Their relatives/carers
• Hospital doctors (including specialist in rehabilitation)
• Nurses – both ward based and specialist
• Occupational Therapists
• Psychologist and/or neuro-psychologist, or psychiatrist
• Speech & Language Therapist
• Hospital Chaplain or other appropriate spiritual support
When does rehabilitation start?
Rehabilitation starts within the first 2 working days of the patient’s arrival at the Major Trauma Centre. Depending on the severity of the injuries sustained, rehabilitation will start on the intensive care unit or on the ward. The Rehabilitation Team, led by a Consultant in Rehabilitation Medicine, will be notified of the the patient’s arrival in hospital and will arrange a visit by one of the team to begin the process of establishing the individual’s rehabilitation needs.These needs are documented on a Rehabilitation Plan on a weekly basis, and goals are set during the patient’s stay by the team of treating nurses and therapists. These goals are checked regularly to see if they have been achieved. Providing the patient and family with education about the injuries sustained and what impact the injuries are likely to have now and in the future is an important part of rehabilitation.
Within the Major Trauma Centre (MTC) there is a Rapid Access Acute Rehabilitation (RAAR) ward based on Ward J2 that can take patients for up to 28 days for a period of multi-disciplinary rehabilitation. A decision is made based on clinical need whether an individual needs to access this service or not. When a patient is discharged from the MTC from either the ward or the RAAR a Rehabilitation Prescription is completed outlining key facts about the patient and their injuries and the rehabilitation that has taken place to date, including a rehabilitation plan after discharge. If further rehabilitation is required appropriate referrals will be made in advance of discharge. If referral to a specialist unit is required this will be made by the MTC team. The majority of patients will be able to go straight home and have follow up in the community, but some people will be transferred back to their local Trauma Unit for a period of time where the local team will continue therapy. The community phase of rehabilitation is just as important as the hospital phase in determining outcome and will focus on getting the patient back into the life roles they had prior to the trauma.
The Trauma Network plans to follow the recovery of patients for up to a year following injury to monitor progress through looking at various outcome measures. These outcome measures form part of a national data collection system, the Trauma Audit and Research network (TARN), and UK Rehabilitation Outcomes Collaborative (UKROC). This will help the Network see if what is being provided for people who have been injured is effective and will guide us in making improvements to services for future patients.