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Rehabilitation

National Clinical Audit

NCASRI 3RD YEAR REPORT FIRST RELEASE

The national audit report data was released in an open format on 12th April 2019. Download the report here and the additional appendices here.

The national audit report data was released in an open format on 12th April 2019 and reports the results of the national prospective audit of specialist rehabilitation following major trauma in England.

The report highlights a shortage of Specialist Rehabilitation beds across the country and estimates that approximately 330 additional beds are needed to meet the shortfall in capacity and relieve pressure on the acute services across the country

However, the findings also demonstrate the cost-efficiency of rehabilitation following major trauma with mean net life-time savings in the cost of ongoing care amounting to over £500,000 per patient, so that any investment in additional beds would be rapidly offset by long term savings to the NHS.

First and second year reports can be found in the Key Project Documents section below.

 


 

The National Clinical Audit of Specialist Rehabilitation for Patients with Complex Need following Major Injury is a major national clinical audit.

It has been commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and is funded by NHS England and the Welsh Government.

This is a 3-year programme (2015-2018) conducted in partnership with the British Society of Rehabilitation Medicine (BSRM) and led by a tri-partite partnership between:

Audit Aim Scope and Design

Overarching Aim

To provide a national comparative audit of the organisation, access to, quality, outcomes and efficiency of English and Welsh NHS and Defence Medical Services (DMS) specialist rehabilitation services provided for patients with complex needs following major injury (physical injury caused by events such as road traffic accidents, falls etc).

Patients covered by the audit include:

  • Adults (16 years and over) admitted to Major Trauma Centres (MTC) who require specialist rehabilitation at discharge (ie have category A or B needs) and who are subsequently referred/admitted to specialist rehabilitation services.
  • As the audit develops the feasibility of extending the scope to include children with complex rehabilitation needs will be explored (subject to grant extension of audit).

Audit sites:

The audit will engage commissioners and providers of major trauma centres and specialist rehabilitation services (Levels 1 and 2). Currently there are no such services in Wales or the DMS. Commissioners at all levels (national, regional and local) will provide data on service commissioned.

At the current time the eligible services include the following:

•            22 designated MTCs providing services to adults

•            all located in England

•            18 designated Level 1 (tertiary) services, commissioned by NHSE

•            16 Level 2a (supra-district) specialist services, commissioned by                     NHSE/CCGs

•             24 Level 2b (local district) specialist services, commissioned by                      CCGs

By definition only services that are routinely reporting the UKROC dataset are eligible for designation as a Level 1 or 2 specialist rehabilitation services

The audit will drive:

  • Improved and equitable access to specialist rehabilitation services for eligible patients
  • Improved physical and psychological recovery, the reduction of long-term disability and improved re-entry to education or the workplace following specialist rehabilitation, for those who are able.

Key objectives

  • Mapping of specialist rehabilitation services
  • Determining their current capacity and quality against published standards
  • Providing prospective individualized information relating to key quality standards, including process and outcomes in relation to patient complexity

Design

Methodologies include:

  1. Survey of commissioners/providers
    1. to identify, map and characterize specialist rehabilitation services that support patients with complex rehabilitation needs
    2. to evaluate provision of organized rehabilitation and assessment on ongoing rehabilitation needs within the Major Trauma Centres
  2. Prospective individual patient data collection and analysis:
    1. Evidence for assessment of rehabilitation needs and a prescription for rehabilitation at discharge from the Major Trauma Centres
    2. Evaluation of needs input and outcomes (using the UK ROC dataset) for all patients admitted to specialist rehabilitation
  3. Patient tracing: we will also evaluate the feasibility of telephone follow-up to trace patients with a prescription for Level1/2 rehabilitation who do not appear on the UK-ROC dataset, to assess the level of rehabilitation received and the extent to which this met their needs.

A priority is the data linkage between the trauma registry database TARN Manchester and the rehabilitation database UK ROC.

  • This will create data-flow between these two major national databases to track patients as they move from acute care services through in-patient rehabilitation, to the community.
  • Patients requiring specialist neurorehabilitation will be tracked along the care pathway to record their needs for rehabilitation, the extent to which these were met and the outcomes that were achieved.

UKROC database for specialist rehabilitation

UK ROC has been set up through a Department of Health NIHR Programme Grant to develop a national database for collating case episode for inpatient rehabilitation (RP-PG-0407-10185, 2008-2015). It now collates from all specialist neurorehabilitation services (levels 1 and 2) across the UK.

  • The database development was undertaken in collaboration with the BSRM and the Australasian Rehabilitation Outcome Centre (AROC)
  • It is a Payment by Results Improvement Project, which has provided information on casemix and episode costs to inform the development of complexity-weighted tariffs.
  • The database will serve to ‘open the black box of rehabilitation’ by providing information on rehabilitation requirements, the inputs provided to meet them, outcomes and cost-benefits of rehabilitation for patients with different levels of need.

UK ROC is led by Professor Lynne Turner-Stokes, and based at Northwick Park Hospital in London.

TARN trauma registry database

The TARN database was established in 1990 to perform clinical audit and research of the care of injured patients. It collects data on patients suffering trauma in England and Wales who are admitted to hospital for ≥72 hours, who require critical care resources or who die from their injuries. Certain injuries, such as fractures of the pubic ramus or proximal femur in those aged >65 years, are specifically excluded.  The Trauma Audit & Research Network has been identified by the Department of Health as the national audit tool and will now also facilitate the Best Practice Tariff for Major Trauma.

The group, which is clinically led, monitors standards of trauma care set out by the Royal College of Surgeons, British Orthopaedic Association and NICE providing each NHS Trusts and Commissioners with case mix adjusted outcome analysis and comparisons of trauma care across the UK. The main objective is to facilitate the development and improvement of trauma services, thereby reducing the associated burden of death and disability.  TARN is based at Salford Royal NHS Foundation Trust and is part of the Academic Health Science Centre at the University of Manchester.

Team

NCASRI Project Management Board 

  • Prof Lynne Turner-Stokes (Lead Investigator) 

  • Miss Antoinette Edwards (TARN) 

  • Dr Krystyna Walton (Clinical Lead) 

  • Prof Derick Wade (Clinical Lead) 

  • Dr John Etherington (Defence Medical Services) 

  • Dr Judith Allanson (BSRM)


NCASRI Project Operational Team members

  • Dr Karen Hoffman (NCASRI Project Manager)
  • Mr Keith Sephton (UKROC) 

  • Ms Heather Williams (UKROC) 

  • Mr Alan Bill (UKROC)
  • Dr Susanna Rota (NCASRI Project Coordinator)

  • Ms Margaret Kaminska (NCASRI Data Clerk)

NCASRI Clinical Advisory Group

  • Lynne Turner-Stokes
  • Karen Hoffman
  • Hannah Farrell
  • Rachel Botell
  • Rosie Yarnall
  • Davina Richardson
  • Michele Ahearne                                            
Audit timelines

The programme includes 3 main elements:

  1.  An organisational audit to identify the specialist rehabilitation services providing care to trauma patients, and to map the pathways of care into and out of these services (July 2015 – June 2016).
  2. A prospective clinical audit of new patients presenting within the major trauma centres who have complex needs and receive specialist rehabilitation (July 2016 – June 2017).
  3. A feasibility study for identifying the pathway and outcomes for patients who require specialist rehabilitation on discharge from major trauma centres, but do not subsequently attend (June 2017 – January 2018).

The work has started on 1st July 2015 with the data-collection based on an organisational survey.

The rehabilitation consultants from major trauma centres and specialist rehabilitation services level 1 and 2 from England and Wales, as well as the commissioners are contacted to provide information about the existing services.

Three annual reports will be made available through the audit website.In the first three years the audit will focus on level 1 and 2 specialist rehabilitation services in England and Wales, the Defence Medical Services and the Major Trauma care centres and thereafter we hope to roll the programme out more widely.The work has started on 1st July with the data-collection based on an organisational survey. The rehabilitation consultants from major trauma centres and specialist rehabilitation services level 1 and 2 from England and Wales, as well as the commissioners will be contacted over the next few months to provide information about the existing centres.

Key Project Documents

Annual Reports

Year 1

The first national audit report data was released in an open format on 28th October 2016. The information made available in the first report includes process and outcome data, current practice and level of involvement of consultants in rehabilitation medicine within the major trauma centers.

  1. NCASRI Audit Report
  2. Key Recommendations
  3. Lay Summary
  4. MTC Summary
  5. Survey Questionnaire
  6. Unit by Unit Analysis of Compliance 2013-15
  7. Unit by Unit Analysis of Compliance 2014-15

Year 2

The second national audit report data was released in an open format on 13th December 2017. The second report addresses the challenges of NCASRI and some of the solutions that we have found and makes recommendations for the next stage of the audit. It also provides some preliminary analysis of data from the Major Trauma centres.

  1. NCASRI 2nd year report
  2. Appendix 1 NCASRI Analysis plan
  3. Appendix 2 Preliminary analysis TARN data
  4. Appendix 3 Workshop report June 8th
  5. Appendix 4 Summary of proposed contract extension combined
  6. Key messages

Year 3

The national audit report data was released in an open format on 12th April 2019 and reports the results of the national prospective audit of specialist rehabilitation following major trauma in England.

The report highlights a shortage of Specialist Rehabilitation beds across the country and estimates that approximately 330 additional beds are needed to meet the shortfall in capacity and relieve pressure on the acute services across the country

However, the findings also demonstrate the cost-efficiency of rehabilitation following major trauma with mean net life-time savings in the cost of ongoing care amounting to over £500,000 per patient, so that any investment in additional beds would be rapidly offset by long term savings to the NHS.

  1. NCASRI 3rd Year Report First Release
  2. NCASRI 3rd Year Report First Release appendices

 

Supporting/guidance documents

The audit will examine at service level: structure, organisation and pathways and at patient level: inputs and processes. Reference standards and indicators are drawn from the following national clinical guidelines and standards documents.

Key policy documents

    1. NCASRI Information Governance Policy (April 2016)
    2. NCASRI Equality and Diversity Impact Assessment
    3. NCASRI Communication Plan
Audit tools

The British Society of Rehabilitation Medicine has proposed a set of core standards and data items for a Specialist Rehabilitation Prescription (SpRP) to be used in patients with category A or B needs requiring referral to the Level 1/2 specialist rehabilitation services following trauma. The SpRP should be completed by a consultant in RM before the patient leaves the MTC. It includes the following tools:

Guidelines on completion of tools are available

  1. Guidelines on completion of tools 
  2. Self-service training slides on PCAT

 Nursing dependency tools:

  • Available here in Nursing dependency self-complete training slides.
Key stakeholders

Key groups that have been identified as priorities are:

  1. MTC, MT Network
  2. Clinicians – trauma and rehabilitation specialists and consultants.
  3. Commissioners of rehabilitation and trauma services – NHS England and clinical commissioning groups.
  4. Patient groups, their family and carers and PPI patients.
  5. Media.

Other stakeholders are:

  1. General public
  2. Researchers, Academics and data managers
  3. Chief executive
  4. Provider managers, services planners
  5. Department of Health
Key policy documents Workshop Reports

All Major Trauma Centres were invited to NCASRI Workshop on 8 June 2017. The workshop report is available here:

NCASRI Workshop report (8th June 2017)

Audit Data

As part of the Government's transparency and open data agenda, the Department has committed to publishing clinical audit data detailing the performance of publicly funded clinical teams in treating key health conditions from 2012.

The national clinical audit of specialist rehabilitation data will be presented in a format to ensure it is accessible to the public as well as clinicians and providers. Publication of the audit data will be managed by the HQIP. 

Analysis and reporting of the audit data will be performed to the level of granularity appropriate to the organisation of care and the response rates achieved. This is likely to be a mixture of trust-level, regional/network- level, and national and will take place annually. All there annual reports produced during the HQIP audit will be available in the public domain, excluding any information that might make individual patients identifiable. Strict security measures are in place to safeguard patient information. 

Aggregate level data from the national audit will be available for use without license or restriction on data.gov.uk (link to https://data.gov.uk/), for patients, public, researchers, developers and healthcare professions. Making this data easily available means it will be easier for people to make decisions and suggestions about government policies based on detailed information. Each dataset will be available at the granularity level of the published report (eg Trust level, regional and national). We will only use your identifiable data (NHS No, gender and date of birth) to link the clinical data within the NCASRI dataset. After that, your identifiable information will be removed from the NCASRI dataset to protect your privacy. In the event of your death we will receive notification of the month and year through the mortality data provided by the ONS.

Patient guidance

 

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BSRM

                  

             

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