A Retrospective Observational Study of Complex Specialist Rehabilitation Needs in a Major Trauma Centre

Research Objectives: To assess whether existing bed capacity for specialist in-patient rehabilitation is sufficient to meet demand within the patient population with complex rehabilitation needs presenting to a Major Trauma Centre (MTC).

Design: A retrospective observational cohort study was conducted on all patients who were reviewed by the MTC’s inpatient trauma service (IPTS) from June 2023 to the 7th of July 2024.

Setting: Cork University Hospital is one of two designated MTCs in Ireland. The IPTS assesses rehabilitation needs, delivers acute rehabilitation, and provides onward referral. Ireland has one inpatient complex rehabilitation centre, the National Rehabilitation Hospital (NRH) with a bed capacity of 120.Due to limited capacity, patients are delayed in transferring to rehabilitation facilities and remain in the MTC or other acute hospitals.

Participants: All patients in the MTC who fulfil the National Office for Trauma Services (NOTS) Trauma Triage Tool and/or the Trauma Audit Research Network (TARN) criteria and those with specific isolated injuries admitted to the MTC.

Interventions: Observational study

Main Outcome Measures: In the absence of Irish standards, the UK’s national standards for a timely transfer to rehabilitation were used. Patients should be assessed within 10 days of referral and transferred to specialist rehabilitation within 6 weeks of being fit for transfer.

Results: 833 patients were reviewed by the IPTS. The average age of patients was 58.3 years, median age 61 year, with the oldest being 98 years old. 12% were discharged to a rehabilitation facility. 3.4%(n=28) required inpatient complex specialist rehabilitation. 28.5%(n=8) were referred to the spinal injury programme, 67.8%(n=19) to the brain injury programme, and 1 required both spinal and brain injury rehabilitation. Only 1%(n=3) were transferred from the MTC to the tertiary specialist rehabilitation centre (n=3). The average wait time for transfer for these three patients was 15 weeks. 3 patients remain an inpatient in the MTC awaiting admission, one of which is 138 days post-injury. The remaining patients were repatriated to acute hospitals, local rehabilitation facilities, or home while awaiting tertiary complex inpatient rehabilitation.

Conclusions: Ireland does not have adequate capacity for patients requiring specialist inpatient rehabilitation. In the absence of Ireland’s own national standards, Ireland is not meeting standards set by the UK, with significant challenges accessing timely complex brain injury rehabilitation. There is a need to better quantify this by more robust data collection including tracking of patients who are transferred from the MTC to other facilities while awaiting complex rehabilitation.

Author(s) Disclosures: All authors have no disclosures or conflicts.