TRAUMATIC BRAIN INJURY RESIDENTIAL REHABILITATION … · 2019. 9. 1. · Annual Report TRAUMATIC...

Annual Report

TRAUMATIC BRAIN INJURY RESIDENTIAL REHABILITATION (TBIRR)

ABI REHABILITATION

Reporting period: 1 July 2018 to 30 June 2019

QUALITY PROVEN

ContentsExecutive Summary ................................................... 1

The Year in Review - Quick Facts ............................... 2

All Intensive Clients ................................................................. 2

DHB/MOH/Private Clients ...................................................... 3

TBIRR Clients ........................................................................... 4

Key Achievements for this Year ................................. 6

CARF Accreditation ................................................................. 6

NZS 8134 Audits ...................................................................... 7

Technology .............................................................................. 7

Cultural Capability ..................................................... 8

Quality Improvement Initiatives ............................. 12

Research Activity .................................................... 14

Research Involvement .......................................................... 14

Other Achievements ............................................................. 15

Workforce Development ......................................... 18

Careerforce ........................................................................... 18

New Members to the Leadership Team ............................... 18

Challenges and Plans for Next Year ......................... 20

Wellington Re-Build Update ................................................. 20

Workforce ............................................................................. 20

Technology ............................................................................ 21

Operational Issues and Resolution .......................... 21

Health & Safety ..................................................................... 21

Contract Matters and Funding Model .................................. 21

Complaints ............................................................................ 21

Summary of Admissions.......................................... 22

Bed Days ................................................................................ 22

Referring Hospitals ................................................................ 23

Funding Sources .................................................................... 24

Emerging Consciousness....................................................... 25

Evaluation of Outcomes .......................................... 26

AROC Data ............................................................................. 26

Service Satisfaction ............................................................... 28

Closing Words ......................................................... 29

ABI Rehabilitation's Vision is... Within a person-centered philosophy, in partnership with its stakeholders, ABI is a national leader in acute and residential neuro-rehabilitation, and a strong community provider, with a local and international reputation for excellence in service provision, and a solid commitment to education and research.

With our mission being...Our hallmarks are service quality, innovation and collaboration.

We strive to serve clients and families-whānau as partners, at the centre of the rehabilitation journey.

We challenge ourselves daily to be leaders in rehabilitation – not for self-interest but to better serve those who have a need, and the right to access exemplary services.

Executive Summary

The volume of clients served and most of their characteristics (ethnicity, gender, age) remained relatively stable compared to the previous reporting period with the following changes.

• Average age dropped by 4 years.

• A higher percentage of Asian and Pacific clients were seen and slightly lower percentage of European-NZ clients.

• The percentage of female clients dropped by 4%.

Tihei mauri oraSneeze of life, call to claim the right to speak

Ehara taku toaMy achievements

I te toa takitahiAre not mine alone

Engari he toa takitiniBut of the many

Kotahi te kaupapaOne mission

Ko te whakaoranga wairoro wharaBrain Injury Rehabilitation

Kotahi te WakaWe are all in this together

CHANGES TBIRR QUICK FACTS

ABI saw more severely injured clients compared to previous reporting period based on.

• An increase in minimally conscious clients being admitted.

• The average Glasgow coma scale (GCS) in ED dropped by 1.

• The average post traumatic amnesia (PTA) duration increased by 4.5 days. Less clients were a short or medium time in PTA (up until a month) and more clients were a long time in PTA (> month).

Other key findings.

• Car accidents and falls account for the majority of TBIs (almost 75%).

• Satisfaction survey results show around 90% of clients and whānau are satisfied or very satisfied with the service.

The following shows some of the key improved outcomes.

• The average length of stay dropped by 1.5 days.

• The percentage of clients discharged home remained stable (86%).

• All the clients that were admitted under the emerging conscious contract emerged from being minimally conscious with average length of stay dropping by more than 50 days.

• The time to commence community rehabilitation improved significantly in the Auckland and Waikato regions (reduction of 12 days which has resulted in an average waiting time of two days).

ABI REHABILITATION TBIRR ANNUAL REPORT 2019 PAGE 1

All Intensive Clients

275 CLIENTS

<20 20s 30s 40s 50s 60s 70s 80s0%

10%

20%

30%

Perc

enta

ge o

f Clie

nts

Average Age = 41.5 years old Range = 15-87 years old

53% European-NZ

25% Māori

9% Asian

10% Pacific

3% Other

279 EPISODES

AKL WGTN AKL WGTN

191

84

192

87

203 73.8%

72 26.2%

Ethnicity

The Year in Review - Quick Facts

Average length of stay:

49 daysMedian length of stay:

31 days(range: 2-207)

PAGE 2 ABI REHABILITATION TBIRR ANNUAL REPORT 2019

25 CLIENTS

72% European-NZ

12% Māori

4% Asian

12% Pacific

15 60%

10 40%

Ethnicity

68% Stroke

16% Hypoxic Brain injury

12% TBI (overseas)

4% Encephalitis

Mechanism of Injury

21 84%

Discharged home

<20 20s 30s 40s 50s 60s 70s 80s0%

10%

20%

30%

Perc

enta

ge o

f Clie

nts


DHB/MOH/Private Clients



35 days(range: 2-207)


249 CLIENTS SERVED

169 IN AUCKLAND

80 IN WELLINGTON <20 20s 30s 40s 50s 60s 70s 80s

0%

10%

20%

30%

Perc

enta

ge o

f Clie

nts


Who are our Clients?

95% About their Injuries

TBIs were most often due to car accidents and falls.

OF CLIENTS HAD A TRAUMATIC BRAIN INJURY

Average Glasgow Coma Scale score in Emergency Department:

Average duration of post-traumatic amnesia*:

9.5(range: 3-15)

30.5 days(range: 1-112)

3-8

9-13

14-15

0% 10% 20% 30% 40%

Percentage of Clients

Gla

sgow

Com

a Sc

ale

Scor

e

46% Vehicle

27% Fall

14% Assault

6% Other

4% Bicycle

3% Sport

51% European-NZ

26% Māori

10% Asian

10% Pacific

3% Other

Med 31-90 days

< 1 week

0% 20% 40% 60%


1 week - 1 month

> 1 month

Leng

th o

f PTA

*of those who were out of PTA prior to discharge from ABI (8% of the clients where PTA testing was applicable were still in PTA on discharge from ABI)

Ethnicity

187 75%

62 25%

ACC Clients FUNDED BY THE TRAUMATIC BRAIN INJURY RESIDENTIAL REHABILITATION (TBIRR) CONTRACT


Clinical Outcomes


40.2 days

Short 0-30 days

0% 20% 40% 60%


Med 31-90 days

Long 90+ days

Percent of clients who were discharged to home:

86%

Emerging Consciousness Service

12 All emerged from minimally consciousness and 10 discharged home

93.3% 93.3%of clients, and

“Overall, how satisfied were you with the service we provided?”

AKL

98.3%WTGN

87.6%

of family-whānau …answered Satisfied or Very Satisfied

Median length of stay:

30 days(range: 2-207 / not including emerging consciousness)



135 days(range: 31-225)


Key Achievements for this Year

CARF AccreditationABI Rehabilitation continues to be the only Commission on Accreditation of Rehabilitation Facilities (CARF) certified rehabilitation provider in Australasia. The service underwent a planned survey in November 2018 and was awarded CARF certification for three years, through to January 2022. CARF complimented and congratulated the leadership team and staff for this achievement.

ABI has been awarded one exemplary conformance. Exemplary conformance recognises a practice that produces outstanding business or clinical results and/or is innovative or creative and beneficial to be shared with other rehabilitations services.

Obtaining an exemplary conformance is very rare. This was for the efforts to respect and embrace important aspects of the Māori culture through its involvement and inclusion of the persons served and the family/whānau in the rehabilitation process. This was demonstrated through ABI’s decision to have an identified staff person in the role of Kaiārahi Kaupapa Māori, direct contact with potential clients when in hospital and the Te Waka Kuaka assessment.

2022In all there were 32 areas of strengths identified. These included (but not limited to):

• highly skilled interdisciplinary team

• working as a leader in the field of Brian Injury Rehabilitation in New Zealand

• involvement in innovations and research within Brain Injury Rehabilitation

• neurobehavioural training and implementation of programmes

• demonstrating advocacy and enthusiasm for serving people with severe brain injury with disorders of consciousness

• providing a holistic programme with involvement of families and significant others

• strong leadership and medical team with expertise to drive continued quality improvements.


ZOOM

The Zoom implementation for telehealth and video conferencing has been completed for the ABI's intensive service. It has enhanced communication and collaboration capabilities and also provides a secure and future-proof platform for remote therapy. We are looking forward to increase the use of telehealth.

The Wellington service was audited against the the New Zealand Health and disability services Standards NZS8134 in July 2018. The service was certified for a three year period from 19 September 2018. The kind of health services included in the certification are Hospital Services- Medical services and Residential disability services- Physical.

The audit findings included four partial attainment (PA) levels. Corrective actions have been completed and submitted to the auditing agency.

FIREWALL/MAIL SECURITY UPGRADE

We have secured our IT Infrastructure with the enhanced Firewall which has Intrusion Prevention Service (IPS) and Antivirus to constantly scan our network traffic and block malicious attacks and unauthorised access to protect clinical data. Mail security has been upgraded to SMX platform which provides inbound and outbound scanning of both message body and attachments. This means we can better protect our network from email-borne threats. We will continue to work on the rules for scanning outbound emails.

WI-FI

We have successfully completed the Wi-Fi roll out to all sites. It is available to staff and increases their mobility around the sites as well as to clients and their families who can now easily stay digitally connected.

DISASTER RECOVERY

To avoid any service disruption in event of longer power failure at our data centre site we have installed generator which keeps technology running for up to 24 hrs.

Technology

NZS 8134 Audit

The Auckland service had a mid-point surveillance audit against NZS8134 in August 2018. The surveillance audit identified two areas for improvement which have been addressed.

The Auckland service recently completed its full certification audit against NZS8134. There was one corrective action arising from the audit related to increasing our civil defense supplies. We have immediately addressed this. The audit also identified areas of continuous improvement which represents excellence in how we deliver services.


26%% Māori Clients at

ABI Auckland

26.3%% Māori Clients at

ABI Wellington

14.53%Top North Island Māori

Population (age 15+)

15.24%Bottom North Island + Top South Island Māori

Population (age 15+)

Admissions data continues to show an over representation of Māori requiring the brain injury rehabilitation services (this is TBIRR clients only).

The mechanism of injury of Māori clients as opposed to non-Māori clients shows some differences:

• in comparison Māori clients acquire a higher percentage of brain injuries from motor vehicle accidents (MVA) and a lower percentage from falls

• the second highest mechanism after MVAs is assaults

• their average PTA duration is slightly lower compared to all other ethnicities (29 days vs. 31 days)

• the average age of Māori clients is significantly lower than the average age of all other ethnicities; 32 years vs. 43 years

• more Māori clients get discharged home 91% vs. 86% all other ethnicities.

Cultural Capability

Average age on admission

Māori 32

Non-Māori 43

Younger than 40 at admission to ABI

Māori 72%

Non-Māori 40%

Length of stay (days)

Māori 40

Non-Māori 43

Discharged Home

Māori 91%

Non-Māori 86%

Self discharges

Māori 10

7 WGTN / 3 AKL

Non-Māori 12

4 WGTN / 8 AKL

Other

Sports Injury

Bicycle

0% 10% 20% 30% 40%

Mechanism of Injury: Māori

30% 40%

Assault

MVA 56.9%

13.8%

18.5%

3.1%

4.6%

3.1%

Fall

Other

Sports Injury

Bicycle

0% 10% 20% 30% 40%

Mechanism of Injury: Non-Māori

30% 40%

Assault

MVA 41.3%

31.5%

12.0%

4.9%

2.2%

8.2%

Fall


The role of whānau (extended families) is recognised as an essential aspect of hauora (wellbeing) for Māori, who are over represented in populations where there is injury of insult to the brain. Whānau knowledge is a potent resource for enhancing recovery outcomes.

Te Waka Oranga describes a process of bringing together whānau knowledge skills, and feelings, with health workers knowledge, skills, and feelings in the context of identifying recovery destinations and to improve outcomes for whānau using the metaphor of a waka.

Te Waka Kuaka is a Māori bilingual cultural needs assessment tool that has been developed to further guide this work, which uses the metaphor of a flock of godwits. Using these two tools with the whānau at ther centre embraces an holistic approach.

Resources and activities are created and introduced to whānau alongside both of these tools.

WĀHI PLACE

WĀ TIME

CLINICAL GOALS

WĀHI WHAI ORANGA

SKILLS & EMOTIONS

PŪKENGA KARE-Ā-ROTO

FINDINGS OF THE JOURNEY

NGĀ HUA O TE HAERENGA

Te Waka Oranga

ABI Rehabilitation places a high value on the Kaiārahi Kaupapa Māori role. In her role, Ngawairongoa continues to use a variety of Māori cultural health models and assessment tools. Models and tools assist us in identifying client and whānau needs and help create a relationship where knowledge sharing is embraced.

These models are also used in staff cultural safety training. Through use of models, tools and training, ABI is able to create an environment of cultural safety for the client, whānau and health workers.

The role of the Kaiarahi Kaupapa Māori has a primary focus on assisting with transitions to and from the service, supporting inpatient rehabilitation and up-skilling staff. In strengthening the success of discharges, there has been a strong focus on relationship building with services and resources in the community.

A key reason for introducing the Kaiarahi Kaupapa Māori role was to improve how Māori can engage in brain injury rehabilitation. Using Wellington as a control group, as we have yet to establish this role in Wellington, data from Auckland indicates some interesting findings.

For example, if we were to take self-discharges as a measure of client participation in rehabilitation, Auckland has demonstrated significantly better results than the Wellington service. However, Māori clients self-discharging continue to be higher than other ethnicities. In the past year there was a total of 11 Māori clients self-discharging; 7 out of the 11 (64%) clients self-discharged in Wellington. These results alone, suggest that Kaiārahi Kaupapa Māori role adds significant value in engaging Māori clients and whānau.

EDUCATIONWhānau groups

Cultural calender celebrations

Te reo orientation

KAIĀRAHI KAUPAPA

MĀORI

ENGAGEMENTWhānau hui

Marae visits and whanaungatanga

Powhiri

ACTIVITIESPuoro

Carving

AFTER DISCHARGE

Whānau contactMarae

whanaunga


Client Story

One never envisions their future, waking up in rehab. So, when you find yourself waking up in rehab following a brain injury you must do a quick adjustment of your life, that adjustment entails changing your future goals, how you are going to function and if you have any physical issues working out ways to manage them.

My stay at ABI Rehab Auckland, changed my perspective on life. The last thing I remember was getting ready for a night in town, then the next time I remember, six weeks had past and I couldn’t move my left arm and, my left leg was in a cast.

Life is the whole cup, both half full and half empty because life is both positive and negative. Looking at life that way has enabled me to make fun of difficult situations to improve my current environment around me.


I had a wonderful team help me. Ben my physio, Charlotte my OT, Stephanie my psychologist, and Maegan my speech language therapist (SLT). I couldn’t have achieved my recovery without them and also other staff that were at ABI, Julia, Laura, (aka thunder thighs and the door kisser), Angelo, Hika, and all of the staff that were with and around me day-in and day-out. My time at ABI was memorable and made so much easier by joking around and laughing all the time. I even enjoyed the naysayers because it helped motivate me to push further and get discharged as fast as I could. I wouldn’t change my time in ABI, everyone was supportive and caring.

The beauty about being human is that we can imagine ourselves in a better position then where we currently find ourselves. Dream Big is a testament to that power of imagination.

I am always moving and looking forward and I have had plenty of difficult situations since rehab. Life doesn’t get easier, you just get stronger. Being self-reflective has enabled me to fix my failures to conquer them the next time I face them.

With my ability to overcome difficulties that am faced with comes from my self-belief. I am nothing special, I believe that everyone too can overcome difficulties that they face in life. They just need to trust in themselves. I want to facilitate that growth through motivational speaking, workshops, and coaching, 1 on 1 or groups. I am working towards that goal everyday and I am grateful to now being offered speaking opportunities. I love helping others and my goal is to just make this world an easier place to navigate for everyone.

With sincere appreciation Ngā mihi mou te whakaaro

William Morris

I thought about quitting, then I noticed who was watching!

LEFT: I was asked to be a guest speaker at Professor Barry Willer’s workshop for brain injury.


TRACHEOSTOMY GUIDELINESA new procedure and end with is being developed with involvement from medical and allied health members, regarding tracheostomy care and weaning competency.

RESPIRATORY GUIDELINESA working group has reviewed and re-written the respiratory clinical care guidelines.

MEN’S SHEDTradesmen and home handy-men suggested a need for an on-site workshop. With input from the clients and the occupational therapists, this has become a reality. "Mateship" offers opportunities to showcase men’s health issues.

CLINICAL REVIEW EVALUATIONWe observed difficulties with knowledge sharing and attendance at clinical reviews. This project resulted in improvements to the flow, purpose, and timing of these meetings and the information being shared. We plan to continue this development with greater automation of the information discussed.

FATIGUE MANAGEMENT A fatigue management programme that can be used in a group or individual setting is being developed.

EVIDENCE BASED REHAB PATHWAY FOR HYPOXIC INJURIESWe have observed increasing numbers of clients admitted following hypoxic brain injury. This client group has different clinical needs. A new set of guidelines for intensive rehabilitation that includes early discharge planning for adequate supports on discharge are being developed. The group developing the guidelines are using an evidence based approach that means we will better support clients to achieve better outcomes.

SCHEDULINGA system to clearly arrange, document, and share client appointments is being developed. This work also includes how to manage changes to the schedules so as not to create confusion.

Quality Improvement Initiatives

As of July 2019, there are a range of quality projects underway at ABI Rehabilitation.

SELF-DIRECTED REHABSome clients report they are 'bored' between rehab activities. A project to identify what 'boredom' is and develop a 'suite' of self-directed rehabilitation activities is underway.

BARIATRIC MANAGEMENTVery heavy clients (known as bariatric clients) increase the risks of injuries for the client and staff through moving and handling. This project aims to better meet the needs of current clients who are needing bariatric support and TBI inpatient rehabilitation (intensive or residential). Findings of this project were shared at the last New Zealand Rehabilitation Association (NZRA) conference and are being used in the design of the new rehabilitation facility being built in Wellington.

BEHAVIOURAL MANAGEMENT TRAININGABI has a team of four allied health staff have recently updated the staff behaviour management training programme. This has been successfully rolled out in Auckland and Wellington and run as a one day workshop to other providers.

TE WAKA KUAKA/TE WAKA ORANGAWe have been using Dr. Hinemoa Elder’s Te Waka Kuaka/Te Waka Oranga tools as part of a systematic cultural needs assessment with clients and whānau. This project is to determine whether Elder’s concept of Te Waka Kuaka meets intensive TBI clients’ needs.

INFECTION CONTROLABI is updating its infection, prevention and control programme. This includes changes to staff training.

EARLY ENGAGEMENT FROM COMMUNITY REHAB PROVIDERAs part of the Pathways Working Collaborative an issue of delayed engagement and limited handover to the community providers was identified. A pilot was initiated that involved prior approval and direct referral from ABI Auckland for clients being discharged to the Auckland and Waikato regions. This pilot has proven to be very successful. It has resulted in improved handovers and a significant reduction in delays to commence community rehabilitation following discharge from ABI Rehabilitation's intensive rehabilitation service. On average there was a reduction of 12 days from discharge to engagement with the community rehabilitation services.



The University of Auckland again hosted this fun-filled event of exploration called Brain Day. Engaging in community education, ABI Rehabilitation explained various brain injury processes and treatments at its stand in the Community Expo section. ABI Rehabilitation presented a standing room only lecture on “Concussions: A Primer” to cap off the event. Throughout Brain Day, ABI Rehabilitation staff enjoyed taking questions and teaching the general public that there is recovery after a brain injury and that help is available. Since the event, ABI Rehabilitation has expressed its interest in further collaboration with the Centre for Brain Research, and hope to educate the public via additional platforms. Once people with brain injuries and family members learn more about this condition and its treatments, they can shed their fear and focus on rehabilitation.

Brain Day

An on-site workshop has become a very productive space, where volunteers work alongside occupational therapists and clients on various woodworking projects. This includes their latest achievement, the renovation of a second hand football table, which the clients have dismantled, sanded and painted. The completed table has been made available for our clients to use on site in their spare time.

Handy Men

Research Activity

Research InvolvementDuring the reporting period, ABI Rehabilitation has contributed to six active university-led research studies, with key leadership roles in four of them. In addition, another three studies have been completed during this same time period and are now in the analysis or reporting phase.

ACTIVE1. Check-in procedure for leisure activities in TBI / Auckland University

Does the frequency of doing a simple check-in improve client engagement in leisure activities?

ABI Rehabilitation is facilitating the intervention and data collection.

2. CORES questionnaire development of a measure of client-practitioner engagement and rapport / AUT

Testing a draft questionnaire with clients to identify the elements of good engagement.

ABI Rehabilitation is handing out questionnaires.

3. Mentoring in TBI study / AUT

ABI Rehabilitation staff are named as a principal investigator in this Health Research Council supported research.

4. Attention and communication / University of Auckland

Is there a link between communication and attentional deficits?

ABI Rehabilitation staff are named as a principal investigator.

ABI Rehabilitation has contributed to focus groups, surveys and family interviews.

IN ANALYSIS/REPORTING1. Therapeutic connection, what matters to Māori / AUT University

What matters most for Māori when working with a rehabilitation practitioner? If/how concepts align with mātauranga Māori?

ABI Rehabilitation has recruited subjects.

2. Mindfulness in Stroke / AUT University

Can mindfulness training improve outcomes after stroke?

ABI Rehabilitation has recruited subjects.

3. Inpatient goals portal / AUT University

Do clients do better when they've got frequent reminders of goals? A tech solution.

ABI Rehabilitation team members were principal investigators, collaborated on design, conduct, and reporting of the study.


During the last year, ABI Rehabilitation’s staff have contributed to:

• peer-reviewed journal publications;

- two as authors

- two with acknowledged contributions for behind-the-scenes research collaboration

• peer-reviewed conference proceedings at six conferences (national / international)

• professional development training sessions

• external presentations to community, professional, and peer organisations.

Peer-reviewed Publications

1. Paula Kersten, Christine Cummins, Mark Weatherall, Nicola M Kayes, Richard J Siegert, Duncan R Babbage, Hinemoa Elder, Greta Smith, Allison Foster, Kathryn M McPherson. Making sense of recovery after traumatic brain injury through a peer mentoring intervention: a qualitative exploration. BMJ Open; 2018;8:e020672. doi:10.1136/bmjopen-2017-020672.

2. Ann Sezier, Suzie Mudge, Nicola Kayes, Paula Kersten, Deborah Payne, Matire Harwood, Eden Potter, Greta Smith, Kathryn M McPherson. Development of a toolkit to enhance care processes for people with a long-term neurological condition: a qualitative descriptive study. BMJ Open 2018; 8:e022038. doi: 10.1136. (Note, ABI contributed to this study on its advisory committee and by recruiting subjects.)

3. William Levack, Kounosuke Tomori, Kayoko Takahashi, Aidan J Sherrington. Development of an English-language version of a Japanese iPad application to facilitate collaborative goal setting in rehabilitation: a Delphi study and field test. BMJ Open 2018; 8:e018908. (Note, ABI Rehabilitation is thanked in Acknowledgements.)

4. Ngawairongoa Herewini. Tihei Mauri Ora: The Sneeze/Breath of Life. Brain Injury Professional 2019; January, pg 20-21.

Professional Training Sessions

1. Robin Sekerak. Understanding How the Brain Works - to Understand the Brain at Work: Living with a Brain Injury (Seminar via Brain Injury Waikato). 7 September 2018.

2. Monique Tupai (ACC), Kate Diesfeld (AUT), Maegan VanSolkema (ABI), Jessica Gardiner (ABI). Rehab Network Practical decisions and strategies when working with a client with limited capacity for consent (Northern regional providers group (NRPG)). 8 November 2018.

3. Emma Baker. Brain Injury and Behaviour: Understanding the Links (Barry Willer Training). 15 November 2018.

4. Maegan VanSolkema. Cognition and Communication following Brain Injury, 14 November 2018; Social cognition and Pragmatic language (Barry Willer Training). 21 November 2018.

5. Angela Davenport, Jessie Broughton-Pole, Sarah Robertson. Nursing through the Journey (National Neuroscience Symposium). 14-15 March 2019.

Other Achievements

“NURSING THROUGHTHE JOURNEY”


1. NZ Psychological Society conference; 5-8 Sept 2018; Auckland.

a. Elisa Lavelle Wijohn. Brain Injury Whānau Action Project: Conducting respectful and effective research with families of adults with brain injury in South Auckland.

b. Elisa Lavelle Wijohn. Brain Injury Whānau Action Project: Educating and strengthening ourselves in order to educate and strengthen others.

2. American Congress of Rehabilitation Medicine (ACRM); 30 Sept - 3 Oct 2018; Dallas, TX, USA.

a. Robin Sekerak. FIM as a Shared Language: Improving Staff Communication, Documentation, Teamwork Using an Available Tool.

3. 6th Asia-Oceanian Conference of Physical & Rehabilitation Medicine (AOCPRM and RMSANZ); 21-24 Nov 2018; Auckland.

a. Richard Seemann. Headache after concussion

b. Richard Seemann. Classification, Epidemiology and Prognostication in severe Traumatic Brain Injury

c. David Cifu, Dr Robin Sekerak. Medical and neuropsychiatric issues related to severe TBI.

d. Howard-Brown C, Cavit M, Wyss C, Tod B, Ruru T. Using Collective Impact to impact TBI rehab in NZ.

e. Howard-Brown C, Cavit M, Wyss C, Tod B, Ruru T. Data and outcomes framework for moderate-severe TBI developed a collaborative.

4. Joint conference of the Australasian Society for the Study of Brain Injury and the New Zealand Rehabilitation Association (ASSBI-NZRA); 2-4 May 2019; Wellington, New Zealand.

a. Maegan VanSolkema, Maegan; Clare McCann; Suzanne Barker-Collo; Allison Foster. Attention and communication following TBI: Making the connection through a meta-narrative systematic review.

b. Maegan VanSolkema and Shona Lees. Hypoxic brain injury post-intensive rehabilitation: Are clients and families ready for discharge?

c. Julia Averill, Helena Lister. The Future of Bariatric Care in TBI: Can we cope with the load?

d. Tony Young, Nina Andreas and Christine Howard-Brown. Enhancing early engagement for transitions to community.

e. Tony Young, Nina Andreas. TBI at ABI: Trends over the past three years.

f. Tony Young, Ben Wassell, Angelo Angeles and Janne Moore. Visual care plans to enhance communication and efficiency.

g. Ngawairongoa Herewini. Māori cultural support: A unique role within brain rehabilitation.

Conference Talks and Posters

5. New Zealand Speech-language Therapists Association and Speech Pathology Australia joint conference; 2-5 June 2019; Brisbane.

a. Maegan VanSolkema, Clare McCann; Suzanne Barker-Collo; Allison Foster. Attention and communication following TBI: Making the connection through a meta-narrative systematic review.

6. Injury 2019; 8 August 2019; Auckland.

a. Angela Davenport, Bensy Mathew, Allison Foster, Leah Young. What are the challenges in managing dual diagnosis (traumatic brain injury and spinal cord injury) cases?

Auckland: 09-831-0070 Wellington: 04-237-0128

ABI New Zealand Ltdwww.abi-rehab.co.nz [email protected]

Helena Lister, Julia Averill

ABI Rehabilitation, Auckland, New Zealand

The future of Bariatric care in TBI: Can we cope with the load?

Introduction MethodsObesity in New Zealand, has become an important and growing health concern in recent years, with 5.5% of adults having a body mass index (BMI) of higher than 40.0 (Ministry of Health, 2017). At ABI Rehabilitation, this has presented an additional challenge in an area of already complex rehabilitation in order to ensure healthcare provision is both effective and safe for staff and clients.

A complex case review was prompted following a challenging and prolonged admission of a client with both bariatric and TBI rehabilitation needs. This initiated a quality improvement project within our rehabilitative service to improve future care of bariatric clients with a TBI in line with current best practice guidelines. ACC bariatric care guidelines were reviewed, but little advice exists for the management of bariatric client specific to TBI rehabilitation.

References1 ACC bariatric guidelines: https://www.acc.co.nz/assets/provider/acc6075-moving-guide-bariatric.pdf

ASSBI/ NZRA, Wellington, 2nd-4th May 2019

Results ConclusionAdditional consideration is required for all clients with bariatric care needs prior to admission including their mobility level, brain injury severity and rehabilitation potential. An interdisciplinary-team approach is necessary for planning, preparation and provision of suitable rehabilitation for all bariatric care needs following a TBI with additional emphasis on environment and equipment.

At ABI rehabilitation we are in the process of developing a pre-admission screening tool to assist with the planning and preparation for bariatric clients in the future. It is an important area of consideration for funders, healthcare and rehabilitation services as it will influence the future practice throughout New Zealand.

Data were gathered incidental to standard service delivery through ABI Rehabilitation New Zealand, Ltd. Views and/or conclusions in this report are those of the author(s) and may not reflect the position of funding or governmental agencies.

A complex case review was instigated following complications of a bariatric client admission.

This client acquired a severe TBI which was characterized by confusion and challenging behaviour.

Which was further complicated by his 167kg weight, non-weight-bearing status and premorbid mobility and respiratory issues. He required four people to transfer, plus specialised equipment to manage the safe working load. The discharge process was also complicated by lack of suitable discharge destinations, limited access to bariatric equipment and high care needs which extended his stay by 3 months over the AROC benchmark due to these complications.

On review of the ACC bariatric guidelines and our quality improvement project, gaps and barriers were identified in service delivery for bariatric clients. These included, access to suitable equipment, appropriate environmental setup, high care and equipment costs and limited suitable discharge destinations.

Methods: Quality Circle

Developing an admissions assessment

Current weight

Past medical history

Previous and current mobility level

Manual handling/ equipment needs/ room sizing

Current level of cognition/ PTA status

Rehabilitation potential/ expected outcome

Challenging behaviour/ mental health issues

Staff training requirements

Nutritional and medical management

Expected discharge destination

Investigate Data/ Information Client complex case reviewReview of clinical guidelines

Review of current ABI policies Review of current equipment

Action PlanPresent complex case review

Develop IDT risk assessment/ pre admission planning tool Develop ABI Policies and procedures for bariatric clientsIdentify bariatric equipment suppliers and bundle costs

Introduce moving and handling training techniques for bariatric clients

EvaluateReview M&H training and practices

Review reported injuries with future bariatric clients

Consider collaborative working with other healthcare services

in future

Implement trialReview policies with clinical governance

Trial pre-assessment tool

Identify Key Issues:Moving and handling safety

Complex discharge planning/ delaysAlert/ concerns relating to injuries

Equipment breakages and supply/ repair costs

BARIATRIC QUALITY PROJECT

3x bariatric beds $17.57/ $15.75 (due to equipment breakages)

Bed rails $3.22 per day

Alternating air mattress $14.85/ $16.36

Bariatric shower commode $32.12

Bariatric flotation chair $28.20

Manual wheelchair $11.55

Gel pressure relieving cushion $5.44

Plus equipment delivery charges

Case review - equipment rental cost breakdown

COST/DAY

Total equipment hire costs during admission:

$34,144.93



Tony Young, Nina Andreas, Christine Howard-Brown


Enhancing early engagement for transitions to community

Introduction Methods

DiscussionChanges required a willingness by ACC to trust improvements co-designed by the Collaborative, of which clients and whānau were a pivotal part. CRS providers were initially sceptical about equity of referral distribution but soon found this was better than the usual process. CRS providers welcomed a timely handover process which provides an excellent opportunity to exchange information between CRS, clients, whanau and ABI staff to ensure the continuity of rehabilitation. Additional resources were needed by ABI Rehab to manage the referral process. Improvements also occurred across the rest of NZ, which is a likely impact from influence of regional and national providers.

The process of setting up traumatic brain injury (TBI) community rehabilitation services requires prior approval by the Accident Compensation Corporation (ACC), as funder. This was associated with frequent delays in community rehabilitation service (CRS) allocation and engagement.

A Collaborative of client and whānau, ACC and DHB representatives and traumatic brain injury providers (inpatient and CRS) worked to solve issues associated with transition from intensive residential rehabilitation to community based rehabilitation. The Collaborative was set up in 2016, championed by ABI Rehab and funded by ACC.

Underpinning the Collaborative, it was assumed that the majority of clients will require a CRS following inpatient and seamless transition will result in better outcomes (1, 2, 3).

The following steps were taken to identify opportunities to improve transitions:

• The current pathway was process mapped

• Barriers causing service delays were identified

• Changes to the process were agreed. This included:

– Removing prior approval

– Direct referral by ABI to CRS

– Development of an equitable referral distribution process for CRS

• A pilot was initiated with CRS providers and ABI Rehab Auckland to test the changes in the Auckland and Waikato regions.

• Baseline: Data from Aug 2014 - Jan 2016 Auckland (n=115) and rest of NZ (n=335) and prospective data from Feb 2016 -Nov 2017 Auckland (n=123) and rest of NZ (n= 411) was collected to measure service timeliness, cost and equity in referral distribution. Financial years 2017 – 2018 (Q1-3) were monitored for trends in transition times and CRS duration.

References1 Powell J, Heslin J, Greenwood R. Community based rehabilitation after severe traumatic brain injury: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2002; 72: 193-202.

2 Willer B, Button J, Rempel R. Residential and Home-Based Postacute Rehabilitation of Individuals With Traumatic Brain Injury: A Case Control Study. Arch Phys Med Rehabil 1999; 80: 399-406.

3 Malec JF, Kean J. Post-Inpatient Brain Injury Rehabilitation Outcomes: Report from the National OutcomeInfo Database. J Neurotrauma 2016; 33(14): 1371-1379.

ASSBI/NZRA, Wellington, 2-4 May 2019

Results

ConclusionRemoval of prior approval has provided continuity of rehabilitation for clients, reducing the overall length of their rehabilitation. This has resulted in savings for ACC estimated at $8,528 per client in addition to rehabilitation service cost reductions (estimated to be as much as much as 47% for some clients). However, there are likely to be multi-factorial reasons for changes in duration and cost of rehabilitation. CRS providers received equitable referral distribution which reduced delays associated with commencing community rehabilitation and improved the handover from residential to community rehabilitation.


A

B

Baseline

By end of 2018

Inpatient Discharge Planning

Inpatient Discharge Planning

ABI contacts community providers

Provider attends meeting and

starts rehab paln

Community rehab

DIS

CHAR

GE

Funder waiting on

report

Referral to community

providerCapacity

Time made to see plan

Community rehab

14 days (median)

YES

NO

Overall length of Rehab Auckland and Waikato (average days)

Post: 127

Pre: 473

Savings est. $8,528/client

Median transition time (days) between TBI Inpatient and CRS

15

0

5

10A

BBaseline 2016 (Q3-4) 2017 (Q1-4) 2018 (Q1-3)

Auckland/Waikato Rest of NZ

Maegan VanSolkema, Shona Lees, Amy Honeysett, Helena Lister, Charlotte McLauchlan, Emma Baker, Stephanie Kennerley, Julia Averill, Kelsey Kyle, Allison Foster


Hypoxic brain injury post-intensive rehabilitation: Are clients and families ready for discharge?

IntroductionA gap in service delivery was identified in transitioning and discharge planning clients following inpatient rehabilitation for hypoxic brain injury (HBI) in New Zealand. Anecdotally, inequalities have been reported in community based services, to the detriment of clients’ long-term outcomes. Further data is required to improve seamless service delivery.

MethodsABI rehabilitation therapists completed structured phone interviews gathering qualitative feedback from client/family members to review “how they are coping after leaving ABI”. This information was analysed with the aim of improving services for future clients with HBI.

Results

DiscussionFamilies reported that overall therapy supports following discharge were inadequate or non-existent and felt under prepared for family members’ return home. Education and information provided whilst at ABI Rehabilitation was excellent, they still felt overwhelmed and underprepared when discharge occurred. Results found that seamless service delivery was poor and varied depending on location, funding source, and service

availability. An unexpected finding was the need for therapists to provided additional support and arrange referrals to meet identified gaps. To address these issues, ABI Rehabilitation has initiated discharge planning from admission.

Positive family and friend supportMaintaining friendships from rehab post discharge

Family unit moved into together

Social changes in the family systemChanging roles – mother to caregiver

Lack of government funding

Utilising external agencies e.g. NZ Disabilities, Blind Foundation, Optionz

Social participationCatching trains and buses

Going to the movies and ten pin bowling

Walking for exercise

“Shake Rattle and Roll”

Discharge location Home

Residential facility

Life after discharge Found life easier

Found life as expected

Found life harder than expected

Families felt unprepared.

Families reported they had inadequate supports set up prior to discharge.

Families sought multiple resources outside of the standard community therapy to fill the gap.

5 family/clients provided experiential feedback:

5



This project was completed by the allied health team members as a quality improvement project at ABI Rehabilitation intensive service, Auckland.

ASSBI / NZRA Conference, Wellington May 2019


Tony Young, Nina Andreas


TBI at ABI: Trends over the past 3 years


DiscussionThe data collected and analyse included those admitted to ABI Auckland and Wellington. It therefore comprises moderate to severe TBI’s with an accepted ACC claim who are over 15 years of age. It does not include clients who did not survive their TBI, those that did no require inpatient rehabilitation or those that declined our services.

The data suggests that there is value in looking at the variables such as mechanism of injury, age, ethnicity and gender to determine if trends are

emerging. With the knowledge we are in a stronger position to plan for service developments and provide useful retrospective data.

An area for future improvement would be to use this data to with forecasting. It is also felt that there would be significant value in gathering greater details about the mechanism of injury e.g. causes of MVAs such as alcohol, speed, distraction. There would also be value in including data from those that did not survive the TBI or did not come to ABI.

In order to plan for service development and provide education to assist targeted prevention campaigns, it is vital to look back and reflect on what the data is telling us. Are we seeing trends emerging? Is there a need to collect additional information along the journey? Is there a shift in patterns?

ABI Rehabilitation has facilities in Auckland and Wellington and is the sole provider for intensive inpatient rehabilitation for moderate to severe brain injury in the North Island.

The data illustrated here represents clients discharged from ABI Rehabilitation between 2015-18.

A retrospective data analysis of clients discharged over a 3-year-period (01/10/15 – 30/09/18) from ABI Auckland and Wellington under the ACC Traumatic Brain Injury Residential Rehabilitation (TBIRR) contract was conducted. Excluded were admissions from the community and re-admissions.

Multiple variables were examined such as age, gender, ethnicity, length of stay (LOS) in hospital and at ABI, discharge destination, injury mechanism and contractual information. LOS considers the time the client was an inpatient and funded under the TBIRR contract. Clients were categorised into age groups (10-year brackets) and by discharge date (year1, year2 or year3 - from October to September the following year). Descriptive statistics were used in order to identify patterns and find trends.



Icons made by Freepik from www.flaticon.com



ResultsCharacteristics of the sample

n = 737

European

Māori

Asian

Pacific 7.9%

9.7%

24.4%

56.4%

Ethnicities

Contracts

Emerging consciousness (EC)25

712 Residential rehab (RR)

Top 3 mechanisms

Falls 32.6%

MVAs 31.5%

Assaults 17.4%

73% 27%

x – age on admission42.5x – # days in hospital19.2x – # days at ABI44.5discharged home88%

Interesting findings

1 Age and mechanism of injury

Almost 50% of the 15-24 year olds had an MVA and close to 80% of the 75+ had a fall

Volume

Lower client volume in year 3 (- 10%) despite population growth (+ 1-2%)

Emerging consciousness

25 Admitted under EC contract 56% were women 22 Emerged from minimally consciousness 54% Discharged homeEthnicities

2

Mechanisms of injury by top 2 ethnicities:

3

4 Māori Clients

24.4% vs 14.7%Māori in contract

region/age:

Māori 25% Assault

18% Fall

40% MVA

17% Other

European-NZ 12% Assault

39% Fall

30% MVA

19% Other

Ben Wassell, Angelo Angeles, Tony Young, Janne Moore


Visual care plans to enhance communication and efficiency


DiscussionThe use of a VCP has the potential to share information safely and more efficiently than the WCP version. The VCP was popular among staff, quickly provided useful/needed information enabling enhanced consistency of care. Most importantly the results indicate that there are definite time saving benefits to the VCP over the WCP allowing greater time to provide services for clients. In this study we looked at 5 pieces of information across 10 staff members who

were familiar to the clients. The reality of the day to day work is that there is a constant need to access client care information in a timely manner. It is suggested that with multiple staff and multiple clients such benefits would be extrapolated. An identified issue of the visual care plan was that some areas required more information than what could be displayed through illustration. The plan to address this was to have a link to the written care plan where required.

Clients within ABI Rehabilitation present with a variety of support needs due to neurological injuries or conditions. The current primary methods of sharing this information among staff has been through individualised written care plans (WCP). WCP comprise of multiple pages of information which staff are required to review several times per day to ensure safe client management. Research suggests that the use of pictures over or in addition to words has demonstrated improvements to attention, comprehension, recall, and adherence within health settings (1).

ABI Rehabilitation’s objective was to develop a more efficient method of sharing important client information through the use of visual care plans (VCP) to improve employee efficiency.

A working group explored the assimilation of written information into a VCP aiming to increase ease of use, reduce time taken to review and maximise patient safety. Input surrounding care plans from nursing/medical, allied health and floor staff that needs to be shared was collected. This included gathering ideas around the illustration.

The final draft was trialled in parallel with the current WCP’s over a 6-week period. The trial took place in one of the residential houses. During this 10 staff members were timed locating 5 pieces of specific client information from the WCP followed by 5 pieces of similar information on the VCP. The time taken to complete this was recorded along with subjective feedback on ease of use and any general feedback.

Results



References1 Houts PS, Doak CC, Doak LG, et. Al. The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Education and Counseling 2006; 61: 173-190.



Consensus among staff was:

Increased ease of use

Increased efficiency

Improved confidence in client management

Greater consistency in client care

However, VCP challenges were reported and addressed.

5.65

Average time to locate the 5 pieces of information was:

minutes compared to 1.85

USING WCP USING VCP

Client: “David Maxwell“ DOB: 01 / 01 / 65

Supervision Transfer board

OUTDOOR MOBILITY

TRANSFER

SHOWERING

COMMUNICATION

x 1 Assist Commode

x 2 Assist Gutter Frame

Poor Hearing Practice Turn Taking

COMMUNICATION

AllergiesAllergic to Penicillin,

refer to care plan


The Wellington team has been working on a project to promote a more consistent and standardised approach to the way we report client related encounters, interfaces and interventions. We determined that FIM was the tool and language as it was discipline free and all staff communication was equally valid and critical to gain a good picture of the total picture of the client.

Dr Sekerak pictured below was instrumental in leading this project with Nurse Manager Fiona Martin and the Director of Rehabilitation Amado Torres. This was a significant project that involved training all staff, questionnaires and positive reinforcement of good rehab focused communication and notes.

ABI presents at ACRM in Dallas

1. Richard Seemann. Panel discussion at the annual University of Auckland Brain Day: Traumatic brain injury: research pathways to the future. 21 July 2018.

2. Jessica Gardiner. 2-hour workshop for Life Unlimited: Case reports on hearing difficulties post-TBI. 04 Sept 2018.

3. Tony Young. Full day workshop participation at the Serious Injury Consumer Advocacy Group. 27 Sept 2018.

4. Emma Baker. Guest lecturer for University of Auckland ABA Programme, PSYCH 751. ABA in TBI How does Applied Behaviour Analysis work with clients with acquired brain injury? 1 October 2018.

5. Emma Baker. Guest lecturer for University of Auckland undergraduate psychology paper. ABA in TBI How does Applied Behaviour Analysis work with clients with acquired brain injury? 2 October 2018.

6. Maegan VanSolkema. Annual guest lecturer for the University of Auckland Masters of Speech Language Therapy Practice courses Speech Science 726 and 736. Cognitive Communication Disorders and Cognitive Communication Disorders in Adults following TBI. October 2018.

7. Robin Sekerak. Presentation to rehab nurses on AAN 2018. Guidelines on disorders of consciousness; coma vs. vegetative state, minimally conscious state; defining chronicity; post-traumatic confusional state vs. PTA. 29 November 2018.

8. Robin Sekerak. Presentation to rehabilitation nurses. Diabetes 101. 28 Feb 2019

9. Amado Torres. University of Santo Tomas (Manila, Philippines), College of Rehabilitation Sciences: Resource speaker. SLP Case-based Studies. 01 February 2019.

10. Tony Young. National trauma stakeholders meeting (National Clinical Network on Major Trauma New Zealand) Wellington: Opportunities and Challenges for our Rehab System. 07 March 2019.

11. Tanya Harris. Brain Day: A Primer on Concussion. 22 March 2019.

12. Tanya Harris. University of Auckland medical school career fair night: Rehab medicine as a field. 23 March 2019.

13. Shalini Vij. Whiteria Polytechnic ENs. Brain injury and opportunities for ENs in this field. March 2019.

14. Patrick Matthews and Christal De Bruyn. Physiotherapy Neuro SIG for Wellington region: LSVT BIG; The Dizzy Patient. March 2019.

15. Tanya Harris. Auckland University: History of Rehabilitation Medicine. 26 June 2019.

16. Maegan Von Solkema, Amy Honetsett, Stephanie Kennerley, Emma Baker. Training community providers in brain injury management: 3 full day workshops. March and April 2019

Workshop Presentations

1. Fiona Martin completed her Post Grad diploma in Rehabilitation through Otago University. July 2018.

2. Shalini Vaj completed her Masters in Nursing with distinction from Massey University. July 2018.

3. ABI had a stand at the annual Brain Day at the University of Auckland and distributed information to the public. 21 July 2018.

4. Maegan VanSolkema and Charlotte McLauchlan provided education and advice on brain injury for a six-episode series on ‘Shortland Street’. September 2018.

5. Stephanie Muncaster, Tanya Harris, Ngawai Herewini, Allison Foster had a stand at the annual Brain Day community expo: 22 Mar 2019.

6. Shona Lees, Maegan Van Solkema set up a formal agreement to collaborate with a Chinese rehab facility; March 2019.

7. Richard Seemann was elected as the Chair of the New Zealand branch of the Australasian Faculty of Rehabilitation Medicine; June 2019.

Other Contributions to Learning and Research


Workforce Development

CareerforceABI Rehabilitation supports staff to complete NZQA qualifications through Careerforce. Staff are involved in gaining qualifications from level 2 to level 4. These qualifications are completed through an earn-as-you learn training model and culminate in gaining a recognised national qualification.

Shona Lees

Shona is the Rehabilitation Service Manager for our Auckland Intensive site. Shona has an Occupational Therapist background predominantly working in community and inpatient neurological rehabilitation settings, as well as within a specialised wheelchair and seating service. Shona has previously worked both clinical and leadership roles and is currently completing her Postgraduate Certificate in Leadership and Management.

New Members to the Leadership Team

Dr. Christine Howard-Brown

As Chief Executive of ABI Rehabilitation, Christine is responsible for the overall leadership of the company together with the Managing Director, driving the company’s strategy and growth.

Christine looks after all aspects of the company’s business and professional responsibilities working with the executive leadership team. Christine has extensive leadership experience and an in-depth understanding of the health and disability sector. She is enthusiastic about creating opportunities to achieve good outcomes for ABI Rehabilitation clients, their families and whānau.

Christine has a special interest in traumatic brain injuries, spinal cord impairment and service integration. Prior to joining ABI Rehabilitation, Christine built a successful career in the health and disability sector having led significant projects including the development of national strategies and action plans.

Dr. Tanya S. Harris

Hailing from the US, Dr. Tanya S. Harris received her medical diploma from Philadelphia’s Temple University School of Medicine in 2002. She went on to graduate at the top of her residency at the University of Kentucky before starting her own rehabilitation practice. Drawn to neurorehabilitation, she went on to earn subspecialty board certifications in Brain Injury Medicine and Electrodiagnostic Medicine. She has had the pleasure of serving as the TBI/Polytrauma Director for Bay Pines Veterans’ Hospital where she helped bolster function and quality of life among combat veterans. She enjoys teaching at local medical schools and volunteering as a medical board examiner in her free time. She is now excited to contribute to brain injury care in New Zealand under the auspices of ABI, Auckland.

Dr. Soyoung Kim

Sue graduated from the University of New South Wales, Sydney and started her rehabilitation training in Australia. She moved to NZ in 2014 and obtained her fellowship as a specialist in rehabilitation of medicine from The Australasian Faculty of Rehabilitation Medicine in 2018

Eight staff completed level 4 Careerforce in 2018. In 2019, we have had 9 staff commenced level 4 Careerforce with four of these staff having already completed it.



The new Kelvin House premises have offered the team an opportunity to have an on-site hydro therapy pool. This has provided clients with the opportunity to enjoy therapy earlier and in shorter bursts.

Pictured is CK finishing off a hydrotherapy session with the rehabilitation team. This type of treatment provides a near weightless experience allowing for greater body movement.

Going Weightless

ABI Rehabilitation has had pet therapy on offer for clients for the past 5 years. Clients thoroughly enjoy their time with the different therapy dogs, getting great benefits from their presence on site.

The dogs are incorporated into clients therapy, working on their goals. Ranging from working on their speech by saying commands, working on their balance by walking the dog or strengthening their weak arm by patting or brushing the dog and working on increasing engagement.

Our latest addition, Daisy, has been recently accredited as a SPCA pet therapy dog, and will visit once a month spending the day working with clients.

Pet Therapy

Challenges and Plans for Next Year

Wellington Re-BuildThe building on Hospital Road is now above ground! There has been continued engagement with a variety of people to ensure we are making the correct decisions on room layout, call systems, hand rails, hoist systems, heating/cooling systems, windows, data points – in fact on pretty much everything. The physical layout is now locked in but continued work (with continued input) will be required to fit out equipment and furnishings.

This build will house 24 bedrooms, a number of offices and meeting rooms, internal courtyards, a large gym, occupational therapy (OT) space, treatment rooms, assessment rooms, assessment kitchen and training rooms. Roll on 2020!

Technology

PATCH MANAGEMENT/RMM SYSTEM

To ensure all our computers and server are regularly patched, we are implementing auto patch management system which forces all our endpoints to check and apply Microsoft Security patches as well as other required patches to update software installed. Part of a patch management system is to be able to remote manage all our endpoints to minimise downtime caused because of computer issues.

WINDOWS 10

ABI Rehabilitation is progressively upgrading its operating system from Windows 7 to Windows 10. This will be completed by the end of 2019.

GOING PAPERLESS FOR NURSING OBS AND AUTOMATE CLINICAL REVIEWS

ABI Rehabilitation is committed to continuously improve its clinical and business processes and workflows. Plans include releasing electronic recording of nursing observations as a feature on the client management system. This will allow nurses to enter the measured observations electronically at the bedside. They will get instant feedback if any actions need to be taken and doctors will be able to review them from anywhere.

In addition, ABI Rehabilitation is working on an electronic form for the clinical review process that e.g. will bring up any open actions from previous reviews. This will make the clinical review more efficient.

Workforce Traumatic brain injury rehabilitation is a specialised area with the need for a highly skilled workforce. There are key roles that continue to be challenging to find people with the required skill base. In recognition of this, ABI Rehabilitation has incorporated this into its workforce strategy. There are four key goals within this strategy that have a focus on building skills and competency to upskill current staff and assist with recruitment as required.


Operational Issues and Resolutions

Health and SafetyABI Rehabilitation monitors all incidents reported within the company using Risk Manager. Through this tool, we are able to monitor for trends in incident types and response to peaks in incidents and/or changes in incident rates. Monthly reports are provided to the clinical governance group and quarterly reports are provided to executive management team.

The most common types of client incidents relate to their TBIs. These include falls and escalating behaviour. No serious injuries resulted from falls this year. The number of incidents has remained stable this last year. Previous years incident data has been trending down (which is a positive result).

ABI Rehabilitation has not had a notifiable workplace injury in the last year.

Contract Matters and Funding Model The Accident Compensation Corporation (ACC) contract for delivering intensive residential rehabilitation services was renewed with ABI Rehabilitation on 1 April 2019. The new contract includes several changes to the prior contract which ABI Rehabilitation is continuing to negotiate with ACC on.

ACC has been changing its commissioning strategy which presents a number of opportunities and challenges for ABI Rehabilitation. ABI Rehabilitation continues to work closely with ACC to help ensure the best outcomes for clients with TBIs can be achieved.

ComplaintsABI Rehabilitation received 16 complaints from clients, their family or members of the public. Complaints ranged from concerns about care (11) to lost property (3) and meals (2). The breakdown of the care concerns relate to:

• timing of medication delivery (2)

• the updating of rehabilitation timetable (4)

• noise (3)

• privacy when discussing treatment plan (1)

• timing of discharge letter (1).

All complaints are managed in accordance with the Health and Disability Commissioner's requirements. Recommendations arising from complaint investigations have resulted in a number of changes.

• All staff who administer medications complete an annual competence requirement.

• A self-directed rehabilitation activities project has been initiated.

• The process for sharing client rehabilitation timetables has been updated.


Summary of Admissions

Bed DaysThe intensive service has 33 beds in Auckland and 18 beds in Wellington. Together, over the course of the year, this means that 18,615 bed days were available. When all occupied bed days and all funded absences were summed, 65.8% were used under the intensive rehabilitation contract held with ACC. This is a 3% increase compared to last year. The proportion for Auckland was 63% and for Wellington 71%.

There is significant seasonal and weekly variation in bed occupancy. Figures for the last financial year are shown in the table below.

FACILITIES NO. BEDS*

DAYS PER YEAR

AVAILABLE BED DAYS

DAYS OCCUPIED** (EXCL. ALL ABSENCES)

% OCCUPIED TBIRR

FUNDED ABSENCES*** TBIRR

TOTAL FUNDED TBIRR DAYS

% FUNDED TBIRR

ABI Auckland

33 365 12045 6908 57.35% 684 (432 BR)

7592 63.03%

ABI Wellington

18 365 6570 4190 63.77% 474 (344 BR)

4664 70.99%

Total 52 365 18615 11098 59.62% 1158 (incl. 776 bed retention)

12256 65.84%

* this is the average number of beds available in the intensive facility for all contracts** incl. day rehab, admission day, only TBIRR contract (ACC and private insurance funded)*** fully funded and bed retention days for hospital, short notice and planned leave, AWOL and Day rehab DNA


10

5

1

4

2

3

6

8

7

9

11

12

13

REFERRING HOSPITALS

TO ABI AKL

TO ABI WGTN

TOTAL

1) Auckland Hospital 76 1 77

2) Hawkes Bay Hospital 2 4 6

3) Hutt Hospital 0 7 7

4) Middlemore Hospital 14 0 14

5) North Shore Hospital 4 0 4

6) Palmerston North Hospital 0 8 8

7) Taranaki Base Hospital 0 3 3

8) Tauranga Hospital 1 0 1

9) Waikato Hospital 55 0 55

10) Waitakere Hospital 2 0 2

11) Wellington Hospital 1 44 45

12) Whanganui Hospital 0 4 4

13) Whangarei Hospital 5 0 5

14) Christchurch Hospital 2 1 3

15) Hawera Hospital 0 1 1

16) Kenepuru Hospital 0 1 1

Other Intensive Rehab 1 0 1

Other Long Term/Rest Home 2 2 4

Community Admission 5 7 12

TOTAL 170 83 253

14

15

16

Referring Hospitals


FACILITY FUNDER AKL WGTN TOTAL BED DAYS*

%

Public Health (MoH, DHB, DSS etc.)

845 240 1085 8.2%

ACC TBIRR 6908 4192 11100 84.0%

Private Insurer/Client 223 40 263 2.0%

ACC Residential Support

211 554 765 5.8%

* total bed days = number of days occupied (excl. all absences)

Funding Sources The proportion of occupied bed days by each of the main funders was calculated. Overall, ACC was ABI’s largest funder, with 84% of occupied bed days.

Emerging ConsciousnessThere were 12 clients (6 more than in the previous reporting period) discharged who were initially admitted when minimally conscious. All emerged from the minimally conscious state. Nine of 11 clients (for 1 client the PTA testing was not appropriate) emerged from PTA prior to discharge from ABI Rehabilitation. Ten clients were discharged home and one went to another rehab facility with a plan to be discharged home. The length of time clients spent in a minimally conscious state decreased by a third compared to last year.

EMERGING CONSCIOUSNESS DATAALL CLIENTS SUB-GROUPS, BASED ON

DISCHARGE DESTINATION

TOTAL DISCHARGED HOME DISCHARGED TO LONG TERM REHAB

Number of Clients

Total 12 10 2*

GenderM 10 8 2

F 2 2 0

Mechanism of Injury

Fall 1 1 0

MVA 11 9 2

Emerged from minimally conscious 12 10 2

Cleared PTA 9* 8 1

Age range Age range 16-56 16-56 26-47

Average number of days

Length of hospital stay 37 35 47

Length of EC contract 22 22 27

Length min conscious 62 60 74

Length of RR contract 113 109 130

* for 1 client PTA testing was not appropriate


Client Story

Life’s a Ride!Joseph Loveridge Mills is a 16 year old Enduro MTB racer from New Zealand. While filming a video on 10 June 2018, Joseph had a big crash causing him to suffer from a traumatic brain injury.

He spent the first week after the crash in the Wanganui Hospital Critical Care Unit where he was in an induced coma for 3 days. He then spent the next 4 weeks in the ABI Rehabilitation Centre. He is now back at home, walking, doing physiotherapy and is the keenest he has ever been to get back on his bike once he gets clearance to ride again from the physiotherapist. Joseph does not want people to be scared away from Mountain Biking because of his experience, but wants people to wear good head protection.

Green Fingered RehabHiraina Tuhiwai is the Gardener at ABI Rehab, maintaining gardens and keeping our lovely environment in good condition. She also spends time working with clients who get a lot out of the garden. "They like different things. I had one client who loved pruning – gave lots of things wild haircuts! Another young woman really liked sweeping because she didn’t want to get her beautiful shoes dirty! I can change tasks depending on the interests of clients and their therapy programme. I think progressing this role to involving clients in a practical way while doing therapy is pretty exciting. They are working muscles, engaging cognitively, interacting socially, all while completing enjoyable practical tasks."


Evaluation of Client Outcomes

AROC DataAustralasian Rehabilitation Outcomes Centre (AROC) data and the forum to discuss this continues to be of value. It provides a good opportunity to reflect and understand the outcomes that have been shared and determine what areas needs more attention.

ABI continues to work with ACC on data collection improvements. Last year we shared all our data related to challenging behaviour and PTA. AROC was able to do a comparison to FIM scores and length of stay (LOS) data to determine if challenging behaviour and/or PTA were significant factors AROC will continue to explore this. It is valuable to have means of benchmark, however, it is important to recognise the limitation of the AROC data when evaluating efficiency and effectiveness of service.


VARIABLE AROC REPORT FACILITY OR BENCHMARK

FY2018 CY2018

Number of TBIsImpairment specific report

ABI Auckland 152 154

ABI Wellington 67 57

Benchmark (AU & NZ specialists, TBI only)

1,112 1,071

All TBI episodes, case-mix adjusted average LOS*

Impairment specific report

ABI Auckland -2.8 -4.6

ABI Wellington +3.0 +8.0


0 0

All TBI episodes, case-mix adjusted average FIM gain*


ABI Auckland -1.2 -0.5

ABI Wellington +4.1 +1.4


0 0

% of clients discharged to private residence


ABI Auckland 82% 93%

ABI Wellington 94% 86%


89% 88%

Dashboard summary**


ABI Auckland

ABI Wellington

* Case-mix adjusted average: AROC case-mix adjusts our data by subtracting each client’s value from the group mean for their Australian National Subacute and Non-acute Patient Classification (AN-SNAP) class. These ‘difference’ scores are then averaged across all clients. The benchmark mean is “0”.

• “Good” LOS values are negative numbers (i.e., shorter than average)

• “Good” FIM gains are positive numbers (i.e., higher than average)

** Dashboard summary: The facility is the black-outlined dot. Size of the dot indicates numbers of clients. Being in the top-right quadrant is “Good”: it means higher functional outcome plus shorter length of stay. The bottom left quadrant is lower functional outcome plus longer length of stay. The other two quadrants indicate mixed outcomes. The other dots represent other TBI specialist providers in Australia and New Zealand.

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SATISFACTION SURVEY # SURVEYS ISSUED OUT

# SURVEYS RETURNED TO US

RESPONSE RATE %

PERCENTAGE OF SATISFIED +VERY SATISFIED

Client; Auckland 197 57 28.9% 98.3%

Client; Wellington 82 16 19.5% 87.6%

Family & Whānau; Auckland 182 40 22.0% 93.3%

Family & Whānau; Wellington 82 15 18.3% 93.3%

ACC Case Owners; Auckland 168 85 50.6% 96.5%

ACC Case Owners; Wellington 75 42 56.0% 90.5%

DHB Acute Services; all sites 31 19 61.3%Auckland: 100%

Wellington: 100%

Community and Long-Term Providers; Auckland 104 48 46.2% 91.7%

Community and Long-Term Providers; Wellington 20 6 30.0% 100%

3 Although this is the lowest satisfaction rating amongst all of the stakeholders, compare it to 2016, when the average percentage satisfied or very satisfied was 25% in Auckland (and 14% in Wellington!). We have put a lot of effort into improving processes for community and long-term providers and it shows in the improved numbers.

Across all groups 87% or more stated that they are satisfied with our services

Service Satisfaction

Overall, our satisfaction survey results are very good, with 87% or more across all groups stating that they are satisfied with our services. Satisfaction rates were also above 90% for ACC case owners, DHB acute services staff, and among community and long-term providers. This is the first year that, in addition to reasonable numbers of surveys being completed among community providers in Auckland (due to the pre-approved TI programme), the satisfaction ratings are also high.

There continues to be challenges in improving the response rate for our surveys. Several new initiatives have been launched at ABI Rehabilitation to address this and to follow up on survey data received. We expect survey responses to improve in the coming months.


Closing Words

ABI Rehabilitation is in a privileged position. We have facilities and teams of experts with the skills to help rebuild lives following the catastrophic event of a traumatic brain injury. When people arrive at ABI Rehabilitation they are typically in a state of significant impairment – fully dependent on others for basic life skills. The family/whānau have experienced a life changing event with uncertainty about the future. Brain injury is typically new to them and they are thrown into our world of rehabilitation. This privilege we have at ABI Rehabilitation, is to be able to assist in this time of need, and is something we take very seriously.

Whilst we appreciate the importance of the data shared within this report and the value obtained by reviewing and analysing the trends, it is vital we remember that these numbers are made up from individuals. Every person with a brain injury has unique needs. If positive, sustained outcomes are to be achieved, the importance of a highly skilled interdisciplinary team working with the client and family/whānau cannot be stressed enough. This is true throughout their journey from hospital stay to inpatient rehabilitation to home with carefully planned and coordinated transitions.

ABI Rehabilitation has continued to strengthen the skills over the interdisciplinary team over the past year. This is evident through the continued education, learning opportunities and involvement in presentations and conferences. The recent appointment to the nurse educator role in Wellington and Auckland will see continued development in this area.

Given the importance of the transition phases (admission into and out of ABI Rehabilitation) we were very excited to have the opportunity to run a pilot project to support earlier community rehabilitation post ABI discharge. Such initiatives, that involved input from the sector of TBI rehabilitation (including consumers,

acute hospital workers, funders, and community providers), truly strengthen outcomes based rehabilitation. This group started with the question – “What would a good outcome for the person served look like?” This pilot has proven to be very successful with positive outcomes (significantly reduced delays in community rehab engagement and improved handover processes) being demonstrated to the client group involved.

The past year has not been without its challenges, but without these, a service would not learn and grow. The recent CARF certification and health certification audit has demonstrated that ABI Rehabilitation is performing at a world class level. It received a full 3-year CARF certification with no recommendations in the services delivery aspect of inpatient rehabilitation. In order to maintain this standard we recognised the need to not only continue to get the basics right and challenge ourselves, but to try new things with a strong focus on continuous quality improvement.

Tony YoungGeneral Manager Rehabilitation Services ABI Rehabilitation


ABI Rehabilitation New Zealand Ltd

www.abi-rehab.co.nz [email protected] 09-831-0070 (Auckland) 04-237-0128 (Wellington)

QUALITY PROVEN

ABI Rehabilitation is the leading provider of intensive rehabilitation in New Zealand with specialist centres in Auckland and Wellington. ABI provides comprehensive services for people with traumatic brain injury (TBI) and stroke.

For more information visit www.abi-rehab.co.nz

ABI Rehabilitation was the first Australasian rehabilitation organisation to achieve CARF accreditation. We first achieved this distinction in 2012 and have maintained it continuously through demonstration of ongoing commitment to continuous quality improvement. Our next CARF survey is planned for January 2022.

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TRAUMATIC BRAIN INJURY RESIDENTIAL REHABILITATION … · 2019. 9. 1. · Annual Report TRAUMATIC...

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