No abstract

No abstract

In contrast, Endocrine, Diabetes and CFS/ME clinics showed a much higher proportion of patients from more affluent backgroundsperhaps reflecting a larger proportion of these patients who live outside our local area. Further research will now be conducted to determine the extent to which these findings may also reflect unmet need and difficulty in accessing more specialist clinics for families living in more deprived areas.Background Intensive early neurorehabilitation is required after severe Acquired Brain Injury (ABI), usually necessitating inpatient care. Adult in-patient Specialist Neurorehabilitation services have been commissioned by NHS England since 2013, but there is no consistent provision and standard for specialist neurorehabilitation services for children. Aims To survey arrangements for ABI children requiring inpatient neurorehabilitation across England. Methods A questionnaire was sent to Lead Clinicians at all paediatric Regional Neuroscience Centres (RNSC) and two stand-alone specialist neurorehabilitation units in England.Centres were asked about neurorehabilitation clinical practice and demographic details of in-patients treated 2012-2015.Results 17 centres responded, 15 RNSC, 2 stand-alone units. Only 29% had neurorehabilitation funding arrangements separate to acute neurology/neurosurgery tariffs. Only 10% had ring-fenced neurorehabilitation beds. Total patients receiving in-patient neurorehabilitation were estimated at 1589 over 3 years (mean/year=530). Numbers increased over time (464 (2012/13); 530 (2013/14); 595 (2014/15)). Estimated mean number of patients treated per centre/year=40 (range 2-98). 18% of centres accepted external neurorehabilitation referrals, 82% did not. 47% had a process for care transfer from ? A3B2 re 3,j?>acute services to neurorehabilitation, 53% did not. Proportion of total neurorehabilitation in-patients classed as severe ranged from 25%-90%. 6% of centres reported having >7 neurorehabilitation in-patients at any time; 41% 2-7; 41%<2. Length of neurorehabilitation stay ranged from 7-375 days. Percentage of cases with distance from centre to home >45 min by road ranged from 3%-100%. Many centres reported staffing deficiencies; 40% had protected time for multi-disciplinary team (MDT) meetings for all members, 20% for some, 40% for none. 86% of MDTs included non-NHS funded members. Most patients were discharged from RNSCs to home, but some were discharged as in-patients to district hospitals or specialist neurorehabilitation unit. Conclusions Considerable neurorehabilitation in-patient activity is taking place in RNSCs, despite general absence of secure funding or dedicated beds. Inter-centre variations in funding,

Aim The Department of Child Development (DCD) at our hospital is the major diagnostic and interim intervention service provider for pre-school children with developmental and behavioural disorders in our country. With increased public awareness and emphasis on early detection, the demand for our services has risen tremendously. This was not met with the traditional medical model of multi-disciplinary service delivery. We implemented a novel triage-track inter-disciplinary service model to enhance access and quality of services. This paper presents our 4-year experience with the triage-track model from June 2010. Methodology Through cause and effect analysis, a triage workgroup identified progressive solutions to improve case-differentiation and service prioritisation. The measures streamlined and defined were: 1) secondary screening and case management pathways in the triage clinic, 2) tertiary diagnostic and interim intervention model for specialised tracks [Learning and Behaviour (LB) track, Autism Spectrum Disorder (ASD) track, and Complex track], 3) documentation standards for continuity of care, 4) interdisciplinary professional roles which promoted cross-disciplinary learning. We conducted three Plan-Do-StudyAction ( . In 2013, 32.2% patients were referred to the specialised tracks for tertiary diagnostic evaluation and management (ASD: 19.2%; LB: 11.7%; Complex: 1.3%). The ASD track achieved significant improvement in wait-time and cycletime for ASD diagnostic evaluation and family-centeredness of services. The LB track enhanced comprehensiveness of diagnostic evaluation and fast-tracked 21% of evaluations for patients. In the complex track, all patients completed full evaluation as targeted within a 6-month period. Conclusion The interdisciplinary triage-track model improved access to services, enhanced operational capacity and quality of care in our centre. Introduction Autism Spectrum Disorder (ASD) is increasingly common, and the department we work in is a key diagnostic and interim service provider for ASD among pre-school children. To improve the diagnostic process and delivery of interim intervention services for children and families referred to our department for ASD, we established an interdisciplinary ASD team, which initiated a Clinical Practice Improvement Project (CPIP) in September 2007 to provide an "ASD track" service. In this paper, we share our learning from this project. Methods The ASD team analysed the root cause through cause and effect analysis. We derived solutions which improved 1) case differentiation mechanism and prioritisation of services, 2) standardisation of diagnostic processes and documentation, 3) continuity of care and case management, 4) cross-disciplinary training and professional standards, 5) family-centeredness of our interim intervention services. We conducted 3 Plan-DoCheck-Action (PDCA) cycles (January 2010-April 2011) before implementing the ASD track service in May 2011. Results This paper presents results of our implementation. From September 2011 to March 2...