The National Audit began in 2015 and ended in 2018. The Audit data was released in an open format in April 2019. The report highlighted 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.
The findings also demonstrate the cost-efficiency of rehabilitation following major trauma with mean net lifetime savings in the cost of ongoing care amounting to over £500k per patient, so long-term savings would rapidly offset any investment in additional beds to the NHS.
This Audit was conducted by the The UK Rehabilitation Outcomes Collaborative (UK ROC) and the Trauma Audit & Research Network (TARN), in partnership with the British Society of Rehabilitation Medicine (BSRM).
Rehabilitation Outcomes Collaborative (UK ROC)
UK ROC is led by Professor Lynne Turner-Stokes who has dual roles at Northwick Park Hospital and the Cicely Saunders Institute at King's College London.
UK ROC was been set up to develop a national database for collating case episode for inpatient rehabilitation. It now collates from all specialist neurorehabilitation services (levels 1 and 2) across the UK.
TARN Trauma Database
TARN is based at Salford Royal NHS Foundation Trust and is part of the Academic Health Science Centre at the University of Manchester.
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.
- Mapping of specialist rehabilitation services
- Determining their current capacity and quality against published standards
- Providing prospective individualised information relating to key quality standards, including process and outcomes in relation to patient complexity
The audit included 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.
The audit engaged commissioners and providers of major trauma centres and specialist rehabilitation services (Levels 1 and 2). Commissioners at all levels (national, regional and local) provided data on service commissioned. Eligible services included:
- 22 designated Major Trauma Centres 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
- Services that routinely reported using the UK ROC dataset for designation Level 1 or 2 specialist rehabilitation services
- Survey of commissioners and providers including; to identify, map and characterise specialist rehabilitation services that support patients with complex rehabilitation needs; and to evaluate the provision of rehabilitation and assessment on ongoing rehabilitation needs within the Major Trauma Centres.
- Prospective individual patient data collection and analysis including; evidence for review of rehabilitation needs and a prescription for rehabilitation at discharge from the Major Trauma Centres, and the evaluation of needs input and outcomes (using the UK ROC dataset) for all patients admitted to specialist rehabilitation.
- Patient tracing including the evaluation of the feasibility of telephone follow-up to trace patients with a prescription for Level 1/2 rehabilitation who do not appear on the UKROC 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 TARN trauma database and the UK ROC database. This created data flow between these two major national databases to track patients as they move from acute care services through inpatient rehabilitation, to the community.
The Audit data will be presented in a format that is accessible to the public as well as clinicians and providers. Publication of the audit data is managed by the HQIP. All reports exclude any information that might make individual patients identifiable.
Aggregate level data from the audit will be available for use without license or restriction on 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.
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:
Find more tools and guidelines (kcl.ac.uk)
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)
- Dr Karen Hoffman (Project Manager)
- Mr Keith Sephton (UK ROC)
- Ms Heather Williams (UK ROC)
- Mr Alan Bill (UK ROC)
- Dr Susanna Rota (Project Coordinator)
Clinical Advisory Group
- Lynne Turner-Stokes
- Karen Hoffman
- Hannah Farrell
- Rachel Bell
- Rosie Yarnall
- Davina Richardson
- Michele Ahearne