There is strong evidence to support the provision of specialist and intensive rehabilitation programmes (BSRM 2014) and that the highest level of neurological recovery occurs within the first three months post injury (Broeks et al 1999, Feys et al 2000). However, clinical data from our patient cohort showed patients were not commencing rehabilitation until after this time window due to delays in access to specialist rehabilitation, specifically our local district general patients would wait on average 87.3 days, and patients awaiting repatriation to local hospitals would wait 35 days from being medically stable before transfer. On analysis of our patient caseload, 70% of the caseload had a Rehabilitation Complexity Score of more than 10 indicating a complex specialist service as determined by Turner- Stokes et al (2007), however our staff to patient ratio fell significantly short of the recommendations for this level of service. Funding for this service type traditionally comes from NHS England. It was hypothesised that these delays and service parameters impacted on patient’s functional outcome and on the wider health economy.
This service pilot aimed to examine whether provision of specialist rehabilitation to neurological patients receiving hyper-acute neurosciences care would result in clinically significant functional improvements and reduce length of stay, and transfers to specialist facilities.