Q Exchange
Life after neurological injury
- Proposal
- 2024
What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?
Patients requiring rehabilitation have identified that outcomes data collected does not match their wants and needs when they leave hospital. Ongoing treatment therefore does not target the areas they wish to improve. Patients move from inpatient to community care where it is hoped they will continue to improve and build on the gains made in hospital.
We will:
- Introduce a patient outcome orientated approach for patients with head and spinal injuries, making sure we deliver an effective service.
In partnership with:
- SE London ICS
- Neuro and major trauma rehab patients
- King’s Health Partners
Phase 1: Identifying patient orientated outcomes:
Patients told us their rehabilitation is often a long process and they wanted to feedback at 6 months, 12 months and 24 months after leaving King’s
Phase 2: Measuring outcomes and carrying out improvement:
Summary scores 6-month post-discharge tell us:
Mean of Global Physical Health Score is 60% (range 20% – 95%) Mean Global Mental Health Score is 59% (range 20% – 100%)
What does your project aim to achieve?
The project aims to:
- Understand outcomes that matter most to patients
- Establish a methodology to capture this information
- Move the project into the improvement phase
- Work with colleagues across South East London to improve care for this extremely vulnerable patient group.
How will the project be delivered?
The project has a well-considered approach as demonstrated by the following:
- Team – A clinical lead was identified and a multi-disciplinary team established with support from the Trust’s Quality Improvement and Patient Outcomes Teams
- Collaborations – Regular updates on the progress of the project are made to colleagues in the South East London Integrated Care System
- Mechanisms – CIVICA (the patient experience software system) is being used to send questionnaires to patients
- Governance- The project is a Trust quality account priority and the project team will continue to report progress to the Patient Outcomes Committee and within Trust reporting structures.
- Risk – A risk register is in place for the project. The top risk identified was that we may exclude groups that are difficult to get views on. The mitigation for this was to talk to the patient experience team and to learn from a research colleague with experience in this area
How is your project going to share learning?
We will present findings to the Trust Exec sponsors and to clinicians across the pathway working across South East London neurorehabilitation pathway including primary care and the inpatient neuroscience wards and aim to publish findings in appropriate mediums and present findings widely.
We will utilise the existing forums of the King’s Health Partners neurorehabilitation seminars and lunch and learn forums alongside the NHSE Pan London rehabilitation collaborative events.
How you can contribute
- We would appreciate a critical friend to look at the work we are doing so that we can improve the project and outcomes.
- We would also appreciate a collaborator and strategist to link our work with national agendas.
Plan timeline
| 1 Nov 2024 | First 24 month questionnaires collected |
|---|---|
| 1 Feb 2025 | Quality Improvement workshops held |
| 1 Sep 2025 | Move to collecting questionnaire data via Epic |
| 1 Apr 2026 | Piloted physiotherapist in the community |
| 6 Sep 2026 | Event to celebrate work |
Comments
Victoria Bancroft 7 Mar 2024
I also wonder if family members' perspectives could be included if there is scope?
Jacqui Wakefield 7 Mar 2024
Thank you. We had a patient family representative on the panel and encouraged those we surveyed to include their family members of significant others in the process of completion but this did not focus specifically on family or carer need. We would certainly consider the roll out to family and carer needs once we have the results from this original piece.
Victoria Bancroft 7 Mar 2024
This project is very valuable in giving voice to patients about what matters most to them in terms of outcome, and importantly how to capture this feedback over time. The process of follow up at different time points post-discharge will allow for a 'looking back' which brings a different perspective on how time spent in rehabilitation was of benefit, and what may have been missed. Furthermore, existing outcome measures place huge emphasis on 'independence', and less on other aspects of experience such as connectedness and healthy co-dependence.
Jacqui Wakefield 7 Mar 2024
Thank you for this observation re the use of independence as the top outcome. Absolutely agree on your points of connection and in particular healthy co-dependence.
Catherine Atkinson 7 Mar 2024
This is a much needed project - understanding what outcomes are important and relevant to those receiving this complex intervention not just those commissioning is key to ensure the services are fit for purpose and reported appropriately.
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Jacqui Wakefield 7 Mar 2024
Thank you, Catherine. There is a huge amount of impairment level data collected. This project is an attempt to also focus on the meaningful impact of our services to patients.
Jonathan Shapey 6 Mar 2024
This is a well-timed, fantastic project that will really benefit our patients.
Hyma Rachabattula 6 Mar 2024
Excellent innovative project to understand outcomes that matter most to patients and to improve care for this patient group.
Kai Lee 6 Mar 2024
A fantastic sounding project. Patient-centred and for a group of people with often significant impact and complex needs. Should promote real values based care which is what we need. Good luck with this!
Jacqui Wakefield 7 Mar 2024
Thank you, Kai. Most of the patients we see have long lasting life impact from their health condition so ensuring we value their thoughts on care is important to us.
Katie McLeod 6 Mar 2024
This is an excellent project to focus on the outcomes that really matter to our neurorehab patients.
Masumi Tanaka 6 Mar 2024
This is an indispensable project to understand how we care for brain and spinal trauma patients . This will allow us to track our patient management and identify where we can improve outcomes and quality of life and when patients leave hospital.. I am excited to see that this would help us to optimise patient care from the point that they come into hospital, managed in intensive care, ward and rehab setting. Numerous critical care brain injury projects could ultimately collaborate with this project.
Vicky Hurwitz 6 Mar 2024
Really important project. This could make a huge difference to the outcome fo this vulnerable under researched group
Dr Omar Mustafa 6 Mar 2024
Patient outcomes first approach combined with value based outcomes.
By addressing outcomes that matter to patients it aligns care delivery to what really matters for patients. This is a key to sustainable care delivery.
Jacqui Wakefield 7 Mar 2024
Thank you, Dr Mustafa. One of the things we felt key was to consider how these measures could lead to change across all settings.
Claire Palmer 6 Mar 2024
This project is an innovative development to find out what really matters to patients, regardless of the service or organisation in which they are cared for. This is how we should be approaching improvement in the NHS, both to ensure best outcomes for patients and to ensure best value for the health service and wider public spending, and should definitely receive the resources required.
Nicola Widdup 4 Mar 2024
Fully support this project which sounds like it would be a very important and worthwhile recipient of funding.
Ellen Triggs 1 Mar 2024
This sounds like a much needed project! Current outcome measures that are used are not relevant to most patient groups and need to be updated and more applicable to patients wants and needs!
katy scott 29 Feb 2024
This project sounds very worthy of funding as current outcome measures don’t really capture the difference and benefit of treatment makes for patients. Their feedback helps to foster a closer relationship with patients in terms of their locus of control and capturing outcomes that are ecologically valid and may be more appropriate/relevant to different cultures and neurodiverse patients.
Jacqui 7 Mar 2024
Thank you, Katy. I really like your comment on giving some control back to our patients. This patient cohort typically spend a long time accessing services and are the experts on their own care.
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