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(Volume 3 / Issue 1)

Psychological Care of Patients with Traumatic Brain Injury Study Day

On 22nd November 2022 we were delighted to welcome clinicians from around the region to a study day focusing on the psychological care of patients who have sustained a traumatic brain injury (TBI). Much attention is often paid to the medical management of TBI, and rightly so, but the effects of TBI are long lasting, and often extend beyond the acute phase of treatment, and beyond the patients themselves.

We were able to bring together an exceptional group of clinical psychologists and mental health practitioners who delivered engaging and thought provoking sessions on topics including post-traumatic amnesia, positive behaviour support, making behavioural recordings and family support. An afternoon workshop focussed on communication strategies, and delegates enjoyed working through patient scenarios together utilising what they had learnt.

The final session of the day, delivered by Dr Greg Dean, was certainly a highlight for many. Dr Dean, a scientist, shared his personal experience of having an Acquired Brain Injury in 2015. He eloquently spoke about his recovery, and in particular the psychological support he received, and changes he has had to adapt to.

Feedback from the day:

• "The afternoon sessions on PTA, practical skills and the patient voice will definitely help me implement new ideas and change some of my current practice."

• "Really enjoyed the variety of content that the sessions brought. I found the patient voice presentation extremely powerful."

• "A Very well organised and run event. The content of the day was great especially for someone who is new to neuro / TBI rehab. There was definitely a lot of take home messages that I will feedback to my department on how we can improve care pathways for those with TBI."

• "Really enjoyed the opportunity to have some face to face training for once!"

• "Rarely is there a training day where all of the talks are incredibly useful. I found the day really thought provoking and stimulating."

If there is a specialist topic you think we should provide a regional education event on, please do let us know. You can contact our Education Lead, Sian Cross

1.      Rehabilitation

• Development of Trauma & Trauma Rehabilitation Co-Ordinator posts at Trauma Units

   

• Development and support of appropriate rehabilitation provision at Trauma Units

  • Therapists have described a greater focus on discharge planning over longer-term rehabilitation provision in many Trauma Units in a drive to sustain bed capacity.

     

•  Develop and improve access to rehabilitation specialists in Trauma Units:

  • Consultants in Rehabilitation Medicine

  • Psychological service provision for all major trauma patients

  • Speech and Language Therapists for major trauma patients

   

2.      Prevention

How to start

• Examine cases of major trauma locally

• Join established initiatives – They are looking for involvement of healthcare professionals/organisations. E.g. Road Safety Partnerships and Violence/Harm Reduction Partnerships.

• Funding - established partnerships often have funding streams. As your ICS develops, collaborative bids to them for funding prevention activity should be looked at. Are there charitable funds available?

   

Prevention initiatives/ideas

• Falls - Falls from standing are the leading cause of trauma in all systems.

Can we prevent that first fall?

Have we looked at the TARN data for these patients - are there particular locations that people are falling? Generate a TARN report looking specifically at falls patients to analyse.

• Road Traffic Collisions

Road safety partnerships are well established in all areas of England and usually hosted by the county council.

• Violence & Knife Crime

Fortunately only a small percentage of major trauma is caused by this in our region but leads to significant morbidity, mortality, and often affects younger people in challenged communities. Community Safety Partnerships or Violence Reduction Partnerships are already established in all local councils and are looking for support from healthcare professionals in their local community initiatives.

3.      Nursing Education

Supporting the identification of ward areas within the region’s hospitals which care for major trauma patients & supporting the nursing staff with the achieving the required education & skills.

Raising awareness of the major trauma educational & skill requirements for ward nursing staff at senior & executive level in the hospitals.

• Should major trauma education be mandatory in acute trusts?

Other factors that require consideration

The identification of major trauma patients within each hospital in order to better understand the patient journeys, leading to improved understanding of requirements for patient care, their rehabilitation and the Nursing education required.

Major Trauma Coordinators / Major Trauma Rehabilitation Coordinators

The Trauma Network Team are pleased to see the development of these posts in Trauma Units is beginning and would like to welcome the following staff to their new roles

Kerry Golland as Major Trauma Coordinator at Broomfield Hospital.

Luis Vales as Major Trauma Coordinator and Sara Eltringham as Major Trauma Rehabilitation Coordinator at Norfolk & Norwich University Hospital.

The introduction of the posts has begun to identify the key issues faced by the Coordinators at Trauma Units:

1. As at the Major Trauma Centre, there is more than one route that the patients can take to come in to the hospital. It is key to identify these routes and ensure all appropriate patients are recorded.

2. There needs to be a central way to develop and share a list of candidate Major Trauma Patients particularly as the patients could be on any ward in the hospital.

3. There should be training on how to predict the Injury Severity Score and therefore be able to identify candidate Major Trauma Patients.

4. There should to be a weekly MDT meeting with both AHPs and nurses attending to report on the medical and rehabilitation progress of the patients. There should be input from a Consultant in Rehabilitation Medicine to this meeting.

5. There should to be a rehabilitation prescription that is accessible to all to enable appropriate updates to be shared on discharge.

    

The Network team are happy to support staff as they develop in their new role.