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National Guideline Alliance (UK). Service coordination: inpatient to outpatient settings for people with complex rehabilitation needs after traumatic injury: Rehabilitation after traumatic injury: Evidence review D.2. London: National Institute for Health and Care Excellence (NICE); 2022 Jan. (NICE Guideline, No. 211.)

Cover of Service coordination: inpatient to outpatient settings for people with complex rehabilitation needs after traumatic injury

Service coordination: inpatient to outpatient settings for people with complex rehabilitation needs after traumatic injury: Rehabilitation after traumatic injury: Evidence review D.2.

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Table 2Summary of the children and young people protocol (PICO/PPC table)

PopulationQuantitative
  • For the coordination and delivery of rehabilitation services part of the question: Rehabilitation services for children and young people (aged below 18 years) with complex rehabilitation needs after traumatic injury, including those with traumatic brain injury, sight loss, and hearing loss, when they transfer from being an inpatient to being an outpatient
  • For the coordination and delivery of rehabilitation services and social services part of the question: Rehabilitation services and social services for children and young people (aged below 18 years) with social service needs and complex rehabilitation needs after traumatic injury, including those with traumatic brain injury, sight loss, and hearing loss, when they transfer from being an inpatient to being an outpatient
Qualitative
  • Children and young people (aged below 18 years) with complex rehabilitation needs after traumatic injury, including those with traumatic brain injury, sight loss, and hearing loss, when they transfer from being an inpatient to being an outpatient. For the social services aspect of this question, the population also have to have social services needs. The views of the families/carers of the children and young people will also be sought.
  • Staff working at inpatient and outpatient rehabilitation services and/or social services for children and young people (aged below 18 years) who have complex rehabilitation needs after traumatic injury, including those with traumatic brain injury, sight loss and hearing loss..
Intervention/Phenomenonof interestQuantitative
  • For the coordination of rehabilitation services part of the question: Rehabilitation services coordination method A (for example, community paediatrician, education representatives [teachers, SENCO], neuro-navigator, trauma nurse coordinators, rehabilitation consultant, rehabilitation coordinators, case managers, key workers, discharge coordinators, GP, social worker, early supported discharge [homefirst], specialist trauma multidisciplinary team/combined clinics, rehabilitation prescriptions, multi-disciplinary discharge planning meeting/consultation, follow up meeting [phone or face to face], interface teams or intermediate care, occupational therapist)
  • For the delivery of rehabilitation services part of the question: Rehabilitation services delivery method A (for example, community, group classes, intensive, multi-disciplinary, cohort clinic, specialist outpatients rehabilitation services, early supported discharge, self-management support, family support, outpatient [at hospital], individual, non-intensive, uni-disciplinary, non-cohort clinic, non-specialist)
  • For the coordination of rehabilitation and social services part of the question: Rehabilitation and social services coordination method A (for example, continuing healthcare assessor, housing occupational therapists, housing officers, community healthcare teams [for example, district nurses], re-enablement specialists, specialist injury/disability voluntary organisations, non-specialist social care/disability/user-led organisations, speech and language therapists, neuro-navigator, trauma nurse coordinators, rehabilitation consultant, rehabilitation coordinators, case managers, key workers, discharge coordinators, GP, social worker, early supported discharge [homefirst], specialist trauma multidisciplinary team/combined clinics, rehabilitation prescriptions, multi-disciplinary discharge planning meeting/consultation, follow up meeting [phone or face to face], interface teams or intermediate care, occupational therapist)
  • For the delivery of rehabilitation and social services part of the question: Rehabilitation and social services delivery method A (for example, hospital/discharge-led social care and rehabilitation coordination at discharge, ‘separate/disconnected’ NHS continuing health care and local authority social care assessments for discharge (including assessments for capital costs like aids and adaptations and care costs like costs of a daily carer), rehabilitation and social care services delivered via completely different funding set up between health and social care, liaison at discharge with relevant voluntary organisations, use of personal budgets at discharge, liaison at discharge with reablement services/intermediate care, liaison with housing occupational therapists and other housing liaison at discharge (e.g. to establish whether disabled facilities grants may be available if adaptations are needed), community-led social care and rehabilitation coordination at discharge, ‘joined up/connected NHS continuing health care and local authority social care assessments for discharge, rehabilitation and social care services delivered via a pooled/coordinated budget method (health and social care))
Qualitative

Methods to coordinate and deliver rehabilitation services themselves and rehabilitation and social services in combination for children and young people when transferring from inpatient to outpatient rehabilitation services, regarded by the population as optimal/not optimal or effective/non-effective.

Themes will be identified from the literature but may include:

  • Rehabilitation prescription
  • Case managers
  • Rehabilitation specialist
  • MDT approach
  • Social worker

ComparisonQuantitative
  • For the coordination of rehabilitation services part of the question:
    • Rehabilitation services coordination method B (for example, any of the above interventions)
    • No coordination
  • For the delivery of rehabilitation services part of the question: Rehabilitation services delivery method B (for example, any of the above interventions)
  • For the coordination of rehabilitation and social services part of the question:
    • Rehabilitation and social services coordination method B (for example, any of the above interventions)
    • No coordination
  • For the delivery of rehabilitation and social services part of the question: Rehabilitation and social services delivery method B (for example, any of the above interventions)
QualitativeNot applicable.
OutcomesQuantitative
  • Critical
    • Patient satisfaction
    • Length of hospital stay
    • Return to nursery, education, training or work
  • Important
    • Overall quality of life including sleep (CHQ-CF80, CHQ-PF-50, EURO-QoL 5D 3L Y, PEDS-QL, SCIM, SF-36, SF-12, SF-6D, SFMA, TARN)
    • Carer impact
    • Unplanned readmission
    • Changes in activity of daily living (Barthel ADL index, COPM, E-ADL-Test, FIMFAM, GAS, Katz, OARS, PAT, PSMS)
QualitativeThemes will be identified from the literature but may include:
  • Rehabilitation prescription
  • Case managers
  • Rehabilitation specialist
  • MDT approach
  • Social worker
ContextQuantitative

Rehabilitation and social care settings for patients with complex rehabilitation needs after traumatic injury

Exclusion:

  • Accident and emergency departments
  • Critical care units
  • Prisons

Qualitative

ADL: Activities of daily living; CHQ-CF80: Child Health Questionnaire self-report (adolescents aged 12-18 years); CHQ-PF-50: Child Health Questionnaire parent-report (children aged 5-18 years); COPM: Canadian occupational performance measure; E-ADL-Test: Erlangen Activities of Daily Living test; EURO-QoL 5D 3L; EuroQol 5 dimensions and 3 levels; FIMFAM: Functional independence measure and functional assessment measure; GAS: Goal attainment scaling; GP: General practitioner; MDT: Multi-disciplinary team; NHS: National Health Service; OARS: Older American resources and services scale; PAT: Performance ADL test; PEDS-QL: Pediatric Quality of Life Inventory; SENCO: Special Educational Needs Co-ordinator; SFMA; Selective functional movement assessment; SF-12: 12 item short-form survey; SF-36: 36 item short-form survey; SF-6D: 6-dimension shortform; TARN; Trauma Audit and Research Network

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