The right care, at the right time, at the right place

Head of Customer Experience and Quality, Andy Pepler, explains why receiving the right care, at the right time, at the right place is crucial to maximising outcomes.

Enhanced recovery pathways in the NHS have long been accepted as the best approach to take to optimise outcomes and the recent use of Enhanced Recovery After Surgery (ERAS) pathways have demonstrated real improvements in outcomes.

A recent study in the Journal of the American Medical Association found the use of these integrated, multidisciplinary pathways reduced time spent in hospital by 30% to 50%, brought similar reductions in complications and lowered re-admissions and overall costs.

The recently developed NHS Major Trauma Network has shown how establishing specialist centres staffed by top surgeons, doctors, and clinicians significantly aids chances of survival after major trauma. The report from NHS England in August 2018 detailed how an extra 1600 patients a year were surviving as a result of their specialist care.

Yet what happens when patients no longer need acute care? These extra survivors invariably need additional and more complex medium to longer term rehabilitation.  How are these managed, when major trauma injuries can cause prolonged disability, affecting patients and families, and putting huge cost burdens on the NHS and social services?

The National Clinical Audit of Specialist Rehabilitation following major Injury (NCASRI) was the first to examine specialist rehabilitation provision after major trauma in adults.  This audit found that in-patient specialist rehabilitation services care for about 950 patients per year – a mere five per cent of the adults admitted to these major trauma centres.

The audit reported that the treatment of major trauma cases requires input from “a wide range of specialists, and often special equipment and facilities, which can only be provided in specialist rehabilitation units. Without the specialist input they need, patients may miss out on the opportunity to optimise their recovery and be left with lifelong disabilities – some of which could potentially have been avoided with the right care”.

It concluded that when the major trauma networks were established there was no provision to set up specialist rehabilitation care and that capacity problems with NHS rehabilitation services had caused a backlog in acute service, resulting in many patients being re-admitted to their local general hospital to await a specialist rehabilitation bed, which may or may not materialise.

These findings prove the need for professional rehabilitation case management to support the excellent, under-resourced NHS service by giving each patient the optimal environment to maximise recovery, including home-based care, where good outcomes can be achieved.

Engaging rehabilitation case managers as early as possible after injury allows for all of the patients’ needs to be considered for the right care to be provided at the right time and in the right place.