Disability and Rehabilitation

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Exploring functional outcomes and allied health staffing levels in an inpatient paediatric rehabilitation unit Penelope J. Ireland, Amanda Francis, Shani Jackman & Kim McLennan To cite this article: Penelope J. Ireland, Amanda Francis, Shani Jackman & Kim McLennan (2017): Exploring functional outcomes and allied health staffing levels in an inpatient paediatric rehabilitation unit, Disability and Rehabilitation, DOI: 10.1080/09638288.2017.1387293 To link to this article: http://dx.doi.org/10.1080/09638288.2017.1387293

Published online: 10 Oct 2017.

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Date: 13 October 2017, At: 12:02

DISABILITY AND REHABILITATION, 2017 https://doi.org/10.1080/09638288.2017.1387293

REVIEW ARTICLE

Exploring functional outcomes and allied health staffing levels in an inpatient paediatric rehabilitation unit Penelope J. Ireland, Amanda Francis, Shani Jackman and Kim McLennan

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Queensland Paediatric Rehabilitation Service, Lady Cilento Children’s Hospital, Brisbane, Australia ABSTRACT

ARTICLE HISTORY

Purpose: This study provides data from a paediatric tertiary hospital on the length of stay, functional improvement and allied health workload for children and adolescents on active inpatient rehabilitation programs. Methods: An audit was conducted of records of patients managed through an inpatient rehabilitation program at a 359 bed tertiary children’s hospital in Brisbane, Australia between December 2014 and December 2015. Data relating to diagnosis, length of stay, functional change, occasions of allied health service and hours of patient attributable allied health professional time were collected. Results: Data on 94 children and adolescents with a total of 102 rehabilitation episodes of care were sourced. The greatest average length of stay was for the “Stroke” group. The highest average allied health professional contact hours were for the “Brain Dysfunction – Traumatic” group. The greatest average functional change was observed in the “Brain Dysfunction- Traumatic group.” Physiotherapy accounted for the largest proportion of allied health professional service time, with an average of 32% of total time. Conclusions: This review from a tertiary hospital-based inpatient paediatric rehabilitation service provides information regarding the length of stay, functional change and allied health workload for children and adolescents on active inpatient rehabilitation programs. As expected, total and rehabilitation episode length of stay, functional improvement and allied health contact and input varied according to diagnostic groups. This information is likely to be of value to other Paediatric Rehabilitation Medicine inpatient units when developing staffing for services and benchmarking service delivery.

Received 2 May 2017 Revised 13 September 2017 Accepted 28 September 2017 KEYWORDS

Paediatric Rehabilitation Medicine; allied health workload; length of stay; inpatient rehabilitation

ä IMPLICATIONS FOR REHABILITATION

 Paediatric Rehabilitation Medicine supports children and adolescents to achieve the highest level possible of physical, cognitive, psychological and social functioning following accident or injury.  There are little data in the literature to inform the optimal allied health staffing levels required for intensive inpatient multidisciplinary for children and adolescents suffering acquired neurological impairments.  Data from this tertiary hospital-based paediatric inpatient rehabilitation program provide information on the length of stay, functional improvement and allied health professional contact for patients across broad diagnostic groupings.  This information is useful for other paediatric rehabilitation services when planning for allied health staffing in service development.

Introduction Children and adolescents who suffer serious illness or severe injury frequently require a period of rehabilitation to regain function and return to community participation [1]. A Paediatric Rehabilitation Medicine service aims to provide children and adolescents with loss of function or ability due to injury or disease, with the highest possible level of independence (physically, psychologically, socially and economically). This is achieved through a combined and co-ordinated use of medical, nursing and allied health professional skills. It involves individual assessment, treatment, regular review, discharge planning, community and school integration and follow-up of children and adolescents referred to that service [1].

CONTACT Penny J. Ireland [email protected] South Brisbane, QLD 4101, Australia ß 2017 Informa UK Limited, trading as Taylor & Francis Group

Acute inpatient rehabilitation involves intensive, multidisciplinary therapy aiming to reduce impairment and disability and to promote a successful transition back to the community [2]. Fuentes et al. [3] recently published data from the United States showing improved functional outcomes in patients managed in a dedicated hospital-based paediatric rehabilitation program. In Australia, most paediatric inpatient rehabilitation services have evolved in tertiary children’s hospitals, often in an acute ward setting. The inpatient multidisciplinary team, led by paediatric rehabilitation medicine specialists, commonly consists of medical and nursing staff and a variety of allied health professionals including allied health assistants, dieticians, music therapists, psychologists, occupational therapists, orthotists, physiotherapists, social workers and speech and language pathologists.

Queensland Paediatric Rehabilitation Service, Lady Cilento Children’s Hospital, PO Box 3474,

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based model for patients admitted under a rehabilitation episode of care. This paper is only discussing data from the cohort of patients admitted under the ward-based rehabilitation episode of care for an acquired neurological condition. Patients with neurological disabilities undergoing routine orthopaedic or neurosurgical procedures were not managed by the rehabilitation multidisciplinary team. Patients undergoing a rehabilitation episode of care received individual and/or combined joint discipline sessions depending upon the specific needs of the child. Where two or more disciplines combined for a session, this was counted as two or more separate episodes of care and the time spent by each discipline recorded accordingly. Patients who were on a ward-based rehabilitation episode of care were identified using the rehabilitation department database. There were small numbers in individual diagnosis specific categories so for the purpose of data analysis, the patients were grouped into five diagnostic classes; (i) Stroke, (ii) Brain Dysfunction – Traumatic, (iii) Brain Dysfunction – Non-Traumatic, (iv) Neurological and (v) Spinal Cord Dysfunction.

Although some evidence exists outlining the efficacy of early inpatient rehabilitation, there remains little information regarding optimal allied health staffing levels to support intensive rehabilitation programs. Turner-Stokes [4] reviewed the evidence for the multidisciplinary management of adults of working age following acquired brain injury in the United Kingdom and noted that intensive and early rehabilitation in an inpatient setting leads to earlier functional gains, reduced length of stay (LOS) and improved functional outcomes. Previously, The British Society of Rehabilitation Medicine [5] had developed clinical standards for inpatient specialist rehabilitation services in the United Kingdom and noted that there was a lack of guidance regarding adequate allied health staffing for inpatient rehabilitation units. An audit of specialist rehabilitation services completed as part of this planning identified that only one-quarter of rehabilitation consultants felt that they had adequate numbers of staff (including allied health staff) to manage the caseload. Although key domains of care have been developed with respect to acute inpatient rehabilitation for paediatric traumatic brain injury [6], there remains little information on the allied health staff-to-patient ratios to maximise outcomes for children during an acute rehabilitation admission. Benchmarking against or following adult rehabilitation staffing guidelines is likely to underestimate the resources required for a paediatric inpatient unit. Due to differences in patient numbers, diagnoses and developmental stages, there is less capacity for group or self-directed therapy in the paediatric setting. There is also a greater requirement for direct supervision to ensure safety. The Australasian Faculty of Rehabilitation Medicine is the peak training and accreditation body for rehabilitation physicians in Australia. This group has published standards for rehabilitation medicine inpatient services for both adults and children, which include proposed staff ratios for allied health professionals by discipline and diagnosis [7,8]. These recommendations were derived by consensus after consultation with experts across Australia and New Zealand. To date, there has been little published literature to support these recommendations. The opening of a 359 bed children’s hospital in Brisbane, Australia in November 2014 led to the establishment of a “subacute” ward, including dedicated paediatric rehabilitation beds for the first time in Queensland. Allied health staffing was a major consideration in establishing a service with a new model of care. Collecting service data gave the subacute ward a unique opportunity to review rehabilitation episodes of care in either an acute or rehabilitation ward setting. At the same time, detailed information on allied health staff activity was also being collected. The purpose of this study is to provide information on LOS, functional change according to the Functional Independence Measure for Children (WeeFIM IITM) [9] and allied health workload for children and adolescents on active inpatient rehabilitation programs, according to broad impairment groups.

Data relating to allied health occasions of service and contact hours were sourced from the hospital-wide database designed to collect allied health professional activity data. Allied health clinicians enter time (in minutes) and activity data (type of intervention) for individual patients on a daily basis. The data collected include both direct patient contact time (e.g., hands on therapy, family consultation, review of equipment and housing) and indirect patient contact time (e.g., multidisciplinary meetings and documentation in patient notes). These data are collated and evaluated by the hospital on a monthly basis. Functional change in an individual child’s performance was measured using the WeeFIM IITM [9], which measures functional skills in children with physical or generalised limitations or restrictions. The WeeFIM IITM considers performance from a caregiver’s perspective and consists of 18 items that are scored using a seven-level ordinal scale. All inpatients over the age of 3 years, who had a rehabilitation episode of care greater than 3 days, were scored on the WeeFIM IITM at admission to, and discharge from, a ward-based rehabilitation episode of care. All WeeFIM IITM were administered by staff who had received formal training and accreditation through the Australasian Rehabilitation Outcome Centre who hold the licence in Australia and are responsible for national training and certification. Data related to age, total hospital LOS, rehabilitation episode LOS, functional change according to the WeeFIM IITM and occasions of allied health professional service and hours of contact were abstracted onto a Microsoft Excel 2010 spreadsheet.

Materials and methods

Data analysis

Study design and participants An audit was conducted of prospectively collected data and the medical records of all patients on an active inpatient neurological rehabilitation program through the Rehabilitation ward at a tertiary children’s hospital in Brisbane, Australia for the 13 months between December 1st 2014 and December 31st 2015. Rehabilitation was offered under a variety of different models: (i) to ventilated patients managed in the Paediatric Intensive Care Unit, (ii) as an “inreach” model to patients admitted under other medical subspecialty teams such as oncology and (iii) as a ward-

Length of stay, functional change and allied health contact data

Descriptive statistics were calculated for total LOS, rehabilitation episode LOS, functional changes according to the WeeFIM IITM, occasions of allied health professional service and hours of patient attributable contact for the five identified diagnostic groups. The LOS data used to calculate the daily allied health contact were adjusted to reflect that activity only occurred during the working week (Monday–Friday). No rehabilitation allied health professional activity occurred on weekends during this time. The WeeFIM efficiency (the change in raw WeeFIM IITM score from admission to and discharge from the rehabilitation ward-based episode of care

PAEDIATRIC REHABILITATION – IMPLICATIONS FOR INPATIENT UNITS

divided by the length of the rehabilitation stay) was calculated for each of the five identified diagnostic groups. The Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee affirms that this study was undertaken in the context of ethical best practice.

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Results Comprehensive data on 94 children and adolescents seen by the Inpatient Rehabilitation Team with a total of 102 hospital episodes of care were sourced for the period December 2014–December 2015 (Figure 1). Seventy-nine of the 102 episodes were identified as ward-based rehabilitation episodes of care. For these 79 episodes of care, there were 73 unique patients, 60% male. The mean age for all patients was 8.5 years (range 1 years–16.5 years). The most common impairment group was “Brain Dysfunction – Traumatic” (27 episodes – 25 patients), followed by “Neurological” (21 episodes – 21 patients), “Brain Dysfunction – Non-Traumatic” (18 episodes – 16 patients), “Stroke” (8 episodes – 7 patients) and “Spinal Cord Dysfunction” (5 episodes – 4 patients).

Figure 1. Flow chart for rehabilitation episodes of care data.

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Length of stay The total average hospital LOS for the 79 patients who underwent ward-based rehabilitation episodes of care from admission to discharge was 34 days with a range of 3–200 days. The average LOS for these patients on the rehabilitation ward was 23 days with a range of 3–176 days (Table 1). The greatest average total LOS (53 days) was noted for the “Stroke” group with the shortest LOS noted for the “Spinal Cord Dysfunction” classification (21 days) (Table 1). When the LOS data were calculated specifically for the 59 children for whom WeeFIM IITM data were also available, the greatest average total LOS (47 days) was seen in the “Brain Dysfunction – Non traumatic” group (Table 2). Functional changes according to the WeeFIM IITM WeeFIM IITM scores were not available for 20 rehabilitation episodes of care (Figure 1) so WeeFIM IITM scores for admission and discharge from the rehabilitation episode of care were sourced for 59 episodes. The number of rehabilitation episodes and LOS data

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Table 1. Length of stay for rehabilitation episodes of care. Length of stay – average total days admitted to hospital (range)

No. of rehabilitation episodes

Group Stroke Brain Dysfunction –Traumatic Brain Dysfunction – Non-Traumatic Neurological Spinal Cord Dysfunction Total

8 27 18 21 5 79

53 30 45 25 21 34

Length of stay – average days within rehabilitation episode (range)

(5–200) (6–133) (10–116) (5–83) (3–52) (3–200)

40 22 26 17 16 23

(3–176) (6–133) (4–78) (3–54) (3–52) (3–176)

Table 2. Functional change for rehabilitation episodes of care.

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Group

No. of rehabilitation episodes

Stroke Brain Dysfunction – Traumatic Brain Dysfunction – Non-Traumatic Neurological Spinal Cord Dysfunction Total

Length of stay – average total days admitted to hospital (range)

7 17 12 18 5 59

32 40 47 24 21 34

Length of stay – average days within rehabilitation episode (range)

(7–56) (8–133) (10–116) (5–83) (3–52) (3–133)

20 31 27 17 16 23

Average percentage improvement (range)

(3–42) (5–129) (4–78) (3–54) (3–40) (3–129)

10 41 18 27 12 26

(0–25) (0–77) (0–39) (2–64) (0–36) (0–77)

Average initial WeeFIM score (range)

Average discharge WeeFIM score (range)

61.4 51 48.5 58.7 86.4 57.1

74.4 110 71.3 92.2 102 89.8

(18–102) (18–102) (18–107) (22–114) (48–126) (18–126)

(18–115) (18–112) (18–124) (48–116) (84–126) (18–126)

WeeFIM efficiency (range) 1.09 3.71 2.28 2.58 0.95 2.6

(0–4) (0–14.6) (0–10.75) (0.12–7.36) (0–3) (0–14.6)

WeeFIM: Functional Independence Measure for Children.

Table 3. Allied health professional (AHP) contact time for rehabilitation subgroups. Group Stroke Brain Dysfunction – Traumatic Brain Dysfunction – Non-Traumatic Neurological Spinal Cord Dysfunction Total

Total Average Total Average Total Average Total Average Total Average Total Average

AHP contact days (range)

Total AHP occasions of service (range)

Total AHP hours (range)

AHP Total contact time per day (direct)

233 (3–126) 29.1 430 (2–93) 15.9 347 (3–56) 19.3 273 (3–38) 13 63 (3–30) 12.6 1346 (2–126) 17

1141 (8–666) 142.6 2290 (2–495) 84.8 1544 (8–333) 85.8 1297 (12–227) 61.8 179 (5–50) 35.8 6451 (2–666) 81.7

1565 (10–876) 195.6 3109 (3–714) 115.1 2089 (10–539) 127.4 1785 (12–285) 85 243 (7–59) 48.6 8850 (3–876) 112

6.7

were recalculated by each of the five diagnostic classes for the 59 individuals where WeeFIM scores were available (Table 2). The average percentage change across all 59 rehabilitation episodes of care on the WeeFIM IITM was 26% improvement with a range of 0%–77% (Table 2). The greatest average percentage improvement was noted for the “Brain Dysfunction – Traumatic” group with 41% and the least average percentage improvement noted for the “Stroke” group (10%). The “Brain Dysfunction – Traumatic group also demonstrated both the second average lowest initial WeeFIM IITM score (51/126) and the highest average discharge WeeFIM IITM score (110/126). Children in the “Brain Dysfunction – Traumatic” group were observed to have the most efficient rehabilitation admission with a WeeFIM efficiency of 3.71 (range 0–14.6), indicating an increase of 3.71 WeeFIM IITM points per day of admission to a rehabilitation ward-based episode of care. Allied health professional contact Allied health professional contact was reported on for 74 episodes of care (missing data on 5 of the 79 episodes of care). There was an average of 81.7 occasions of service provided by allied health professionals per rehabilitation episode with an average of 112 total patient attributable hours per episode (Table 3). The average daily time attributed to each patient on a rehabilitation program was 6.6 h per day (Monday–Friday). The greatest average allied

7.2 6.0 6.5 3.9 6.6

health professional hours per diagnostic group was for “Brain Dysfunction – Traumatic” (7.2 h/patient/day) followed by “Stroke” (6.7 h/patient/day), “Neurological” (6.5 h/patient/day), “Brain Dysfunction – Non-Traumatic” (6.0 h/patient/day) and “Spinal Cord Dysfunction” (3.9 h/patient/day) (Table 3). The patient attributable hours by each individual allied health discipline were calculated for each of the five diagnostic groups (Table 4). Physiotherapy accounted for the largest proportion of allied health professional service time provided to three of the five main diagnostic groups (ranging from 28% for patients with “Stroke” to 50% for patients with “Spinal Cord Dysfunction”) with an average across all rehabilitation groups of 32% (Table 4). Occupational therapy was identified as the second highest contributor of allied health services across all diagnostic groupings (mean 28%; range 26% (“Brain Dysfunction – Non-Traumatic”) to 35% (“Spinal Cord Dysfunction”)). Neuropsychologists and miscellaneous allied health groups (including rehabilitation engineers and indigenous liaison officers) were the least frequently utilised group in the inpatient phase (Table 4).

Discussion Data reflecting actual utilisation of allied health resources in paediatric rehabilitation are limited in the literature. This review of data from a tertiary hospital-based inpatient rehabilitation service

PAEDIATRIC REHABILITATION – IMPLICATIONS FOR INPATIENT UNITS

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Table 4. Allied health professional (AHP) percentage distribution for rehabilitation subgroups. Group

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Stroke Brain Dysfunction – Traumatic Brain Dysfunction – Non-Traumatic Neurological Spinal Cord Dysfunction

Allied health assistant

Occupational therapy

Orthotics

Music therapy

Neuro psychology

Nutrition and dietetics

Physiotherapy

Social work

Speech therapy

1 1 0 0 0

29 28 26 30 35

2 3 2 3 6

5 2 4 4 3

0 0 1 1 0

1 3 3 2 0

28 32 34 29 50

14 11 8 12 3

20 20 22 19 3

in Brisbane provides information regarding LOS, functional change and allied health professional workload for children on a wardbased neurological rehabilitation program from December 2014 to December 2015. The analysis only includes patients admitted to the inpatient ward for rehabilitation following acquired neurological injury or illness causing functional impairment. Thus, the data may not be directly comparable to a service with different casemix. As expected, the total and rehabilitation episode LOS and functional change varied according to diagnosis. With small numbers as a limitation, care must be taken in interpreting and generalising the results. A number of individual factors influenced the LOS in this cohort of children. The children who were involved with child protection services had longer LOS than the children who were a part of an intact family unit, as discharges were frequently delayed due to challenges in identifying appropriate caregivers. The children with feeding and communication difficulties with or without physical impairments also tended to have increased LOS. This was often the case in the “Stroke” and the “Brain Dysfunction – Non-traumatic” groups and was contributing factors to the longer LOS within the ward-based rehabilitation episodes of care for these categories. Additionally, children with catastrophic injuries who showed minimal improvement on the WeeFIM IITM from admission to discharge tended to have prolonged LOS while appropriate equipment, house modifications and in home supports were sourced. Kim et al. [10] in a US-based study analysed a large cohort of children and young people admitted for inpatient rehabilitation and found that patients with spinal cord injury had a significantly longer LOS than other diagnostic groups (corrected mean LOS 31.6 days). This was not supported by data from this review where the Spinal Cord Dysfunction group had a mean rehabilitation episode LOS of 16 days. However, this is likely to reflect the small number of patients with spinal cord dysfunction (which included no complete injuries) and the fact the ventilated, high-level spinal injury patients in the Paediatric Intensive Care Unit were not included in this analysis. Those children with “Brain Dysfunction – Traumatic” had the most efficient rehabilitation admission, with the children gaining on average 3.71 points on the WeeFIM IITM per day of hospital admission. This may reflect the predictable natural physical recovery seen in the early months following closed traumatic brain injury [11]. Data from this cohort indicated that patients received an average of 6.6 h of allied health professional patient-related time per day. “Intensive” inpatient rehabilitation has been variably defined as between 2 and 3 h of therapy a day with two or more therapy types [12]. By this definition, patients on a rehabilitation episode of care were receiving intensive therapy during the ward-based phase of their rehabilitation. A number of authors have noted that a greater intensity of intervention has resulted in improved functional outcomes [13]. This review was not designed to look at intensity and functional change. Further research that investigates the impact that the intensity of therapy has on functional change and LOS is warranted. Physiotherapy and occupational therapy accounted for the greatest proportion of allied health time for all impairment

categories, but particularly for the Spinal Cord Dysfunction group. This is likely to represent the intensely physical focus required during the inpatient rehabilitation episode for retraining independence in mobility and transfers as well as equipment trialling, prescription and home modification prior to discharge. It is acknowledged that other disciplines may have greater input following discharge because the changing focuses of rehabilitation later in recovery. The occasions of service and time provided by the social workers across all groups were similar (8%–14%) with the exception of Spinal Cord Dysfunction (3%), again likely reflecting the absence of severe spinal cord injuries included in the data collection. In our service, social workers are the primary providers of psychological support to patients and their families. Clinical psychologists may have this role in other services. The neuropsychologists’ major focus is during the outpatient rehabilitation phase so contribution to inpatient staffing was very low. As expected, speech pathology input was similar across the majority of groups with relatively little contribution to the Spinal Cord Dysfunction groupings, again influenced by the lack of high spinal cord injuries in the cohort. Music therapy, dietetics and nutrition and orthotic support were consistent at lower levels across all groupings. The Australasian Faculty of Rehabilitation Medicine has published “Standards for Paediatric Rehabilitation Medicine Inpatient Services in Public and Private Hospitals (Paediatric Standards)” [8]. These standards include recommended allied health staff ratios, the “ideal number to run a generic tertiary hospital-based service with a predominance of neurological rehabilitation.” Taking into account an additional 30% for non-clinical time and the standard working day (7.6 h), it can be extrapolated that the patients in this cohort were cared for by a team of 11.3 full-time equivalents of allied health staff per 10 patients. Overall, our staffing numbers were slightly lower than those recommended in the Australasian Faculty of Rehabilitation Medicine Paediatric Standards. Our team did not consist of all the disciplines in the Australasian Faculty of Rehabilitation Medicine standards; however, it is likely that different disciplines were providing similar care (e.g., music therapy vs. child life/play therapy). There a number of limitations to this data review. The total number of patients on inpatient rehabilitation programs from December 2014 until December 2015 is relatively small. It is also important to note that the cohort reported on did not include patients managed in the Paediatric Intensive Care Unit, nor those children where the primary medical care was being provided through another medical subspecialty, e.g., oncology. The challenges associated with interpreting data from relatively small numbers were the key factors leading to the national development of a standardised set of outcome data for Paediatric Rehabilitation currently being developed by the Australasian Rehabilitation Outcomes Centre. This will enable the collection of data from multiple centres and provide the opportunity for benchmarking, giving much needed information regarding efficacy and efficiency of inpatient paediatric rehabilitation care. Although this retrospective study gives a “snapshot” of the LOS and allied health professional contact for patients on an inpatient

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rehabilitation program, we neither have information on the type of therapies given nor on the method of delivery (e.g., group or individual). In addition, this paper only analyses the allied health professional contact during the rehabilitation phase of care and does not take into account the rehabilitation team contact time during the acute phase (which occurred frequently for assessment and transition of care to the rehabilitation team) nor the day hospital/intensive outpatient phase of management. Further research that investigates the correlations between intensity of therapy with functional change and LOS is warranted. This will help develop a greater understanding of allied health staffing levels and models of care that will maximise effectiveness and efficiency within a paediatric tertiary rehabilitation service.

[2] [3]

[4]

[5]

[6]

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Conclusions We have presented data relating to LOS, functional outcome according to the WeeFIM IITM and allied health professional workload for patients on an inpatient paediatric neurological rehabilitation program at a tertiary children’s hospital in Brisbane, Australia. The purpose of this review was to provide staffing and outcome data from the first 13 months of operation for a separate “subacute” ward in a newly built children’s hospital that opened in late 2014. The information is likely to be of value to other paediatric rehabilitation medicine services, acknowledging that services may have different case-mix, models of care and combinations of allied health professional staff to provide multidisciplinary inpatient rehabilitation.

[7]

[8]

[9]

[10]

Disclosure statement The authors report no declarations of interest.

References [1]

Ault J, Flett P, Russo R, et al. Pediatric rehabilitation medicine: training requirements handbook. 1st ed. Sydney, Australia: Australasian Faculty of Rehabilitation Medicine, Royal Australasian College of Physicians; 2010.

[11]

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[13]

Jaffe KM. Pediatric trauma rehabilitation: a value-added safety net. J Trauma. 2008;64:819–823. Fuentes MM, Apkon S, Jimenez N, et al. Association between facility type during pediatric inpatient rehabilitation and functional outcomes. Arch Phys Med Rehab. 2016; 97:1407–1412. Turner-Stokes L. Evidence for the effectiveness of multi-disciplinary rehabilitation following acquired brain injury: a synthesis of two systematic approaches. J Rehabil Med. 2008;40:691–701. Turner-Stokes L, Williams H, Abraham R, et al. Clinical standards for inpatient specialist rehabilitation services in the UK. Clin Rehabil. 2000;14:468–480. Rivara FP, Ennis SK, Mangione-Smith R, et al. Quality of care indicators for the rehabilitation of children with traumatic brain injury. Arch Phys Med Rehabil. 2012;93:381–385. Australasian Faculty of Rehabilitation Medicine (Royal Australasian College of Physicians). Standards for the provision of inpatient rehabilitation in public and private hospitals. Sydney: Australasian Faculty of Rehabilitation Medicine; 2011. Australasian Faculty of Rehabilitation Medicine (Royal Australasian College of Physicians). Standards for the provision of paediatric rehabilitation medicine. Sydney: Inpatient Services (PRMIS) in Public and Private Hospitals Sydney; 2015. Uniform Data System for Medical Rehabilitation. The WeeFIM II Clinical Guild, Version 6.0. Buffalo: UBFoundation Activities Inc.; 2006. Kim CT, Greenberg J, Kim H. Pediatric rehabilitation: trends in length of stay. J Pediatr Rehabil Med. 2013;6:11–17. Anderson V, Le Brocque R, Iselin G, et al. Adaptive ability, behavior and quality of life pre and posttraumatic brain injury in childhood. Dis Rehab. 2012;34:1639–1647. Commission of the Accreditation of Rehabilitation Facilities (CARF) International. Medical rehabilitation standards manual. Tucson, AZ: CARF; 2014. Turner-Stokes L, Disler PB, Nair A, et al. Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev. 2005;(3):CD004170.

Exploring functional outcomes and allied health staffing levels in an inpatient paediatric rehabilitation unit.

This study provides data from a paediatric tertiary hospital on the length of stay, functional improvement and allied health workload for children and...
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