sTBI Rehabilitation workstream

Extensive scoping work completed in the early stages of the project included regular meetings with the project’s expert advisory group, engaging with consumers with lived experience of TBI, conducting trauma team surveys, connecting with allied health professionals about current practice and visiting regional hospital sites. 

This consultation identified that systematic screening of brain injury in patients who were admitted to hospital with major trauma were limited, particularly for people who did not lose consciousness (as measured with the GCS) or had a normal CT scan of the head.

In total, 65 percent of hospitals surveyed reported that trauma patients were discharged home without an appropriate head injury assessment; in 30 percent of cases, this was a moderate occurrence (one to three patients per month), and in 35 percent it occurred frequently (most weeks). A total of 40 percent of hospitals reported that they had no systematic processes to identify trauma patients with a TBI. Screening for a brain injury was often challenging on weekends and after hours because of staff shortages and a lack of allied health professionals working.

The presence and duration of PTA is a well-known prognostic indicator of long-term recovery and return to functional independence. Severity of TBI is also based on duration of PTA. The TBI severity classifications as recognised within ACC criteria are:

• Mild TBI: GCS score 13–15; PTA duration <24 hours
• Moderate TBI: GCS score 9–12; PTA duration 1–6 days
• Severe TBI: GCS score 3–8; PTA duration ≥7 days

Ambitiously, the goals for this project are:

• Identification – systematic screening of all (major) trauma patients
• Assessment – completed PTA assessment on all identified patients
• Outcome – positive patient and whānau experience.

Two quality improvement approaches have been used in this work:

• co-design involving consumers to identify and understand problems and issues and to design and implement resolutions[1]
• working with local project teams to resolve problems and issues via a national collaborative.[2]

Footnotes

[1] Te Tāhū Hauora Health Quality & Safety Commission. 2023. The co-design process. URL: www.hqsc.govt.nz/resources/resource-library/the-co-design-process. Accessed 21 April 2023

[2] A collaborative involves bringing regional project teams together for three in-person learning sessions over the course of a year. The focus of these sessions is learning from each other and recognised experts in the topic area and learning quality improvement methodologies (tools and techniques). The teams take the learning ‘home’ and work on their projects between each learning session – known as the action period. Support during the action periods is provided by the national project team and peers through Zoom meetings, online forums and on-site mentoring visits. The end products/outputs are written summaries of the projects that others can learn from and replicate to resolve similar issues. (Institute for Healthcare Improvement. 2003. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: IHI.)