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Acute Brain Injury Pathway and Head Injury Clinic

This is the first such rehabilitation pathway in the UK and it has undoubtedly improved the quality of care for all patients admitted to Sheffield Teaching Hospitals with brain injury. Prior to 2007, there was no such thing as an acute brain injury care pathway anywhere in the UK.

The management of brain injury is complicated and requires a variety of specialist skills. Without proper planning at hospitals, patients can end up under a number of different departments and Brain injury specialists in rehabilitation medicine are rarely involved at an early stage. There is often no coordination of overall care needs and the lack of responsibility leaves patients and families with a poor service.

Many people who suffer a head injury may need to stay in hospital for a few hours until it is clear that they have not suffered any serious complications. They are admitted to the Head Injury Observation unit and monitored for a few hours. Very severe injuries may of course require transfer for neurosurgery or be admitted to an intensive care bed.

Those patients who need to stay in hospital beyond 48 hours come under the care of the Brain Injury team.

This team consists of a specialist doctor, a nurse specialist and a social worker. There is access to specialist physiotherapy and occupational therapy as well.

The team will review all patients regularly and arrange or chase up any further tests that are required. They meet and support family, provide information and act as a key link between the different services involved in brain injury, including services in the community. The team has facilitated smooth transitions and appropriate follow up or review by relevant specialists.

If longer admission is required, then transfer to a neurorehabilitation bed on Osborn 4 can be arranged. The team social worker has a clear role in liaising with families to provide support, and can signpost to other resources such as Headway or assistance with state benefits.

Brain Injury Clinic

A Brain Injury Clinic has been set up for follow-up and for those patients discharged straight from A&E. This multidisciplinary clinic reviews patients every Tuesday and identifies any on-going problems. We undertake appropriate assessments and arrange any necessary treatment or referrals to other specialties. About 5% of even mild head injuries have significant symptoms at 1 year and it is known that appropriate management of mild head injury can reduce later problems.

One of the key benefits of the pathway has been to educate hospital staff as to the significance of brain injury and its treatment. A rolling programme to train nursing staff, junior doctors and therapists is in place, and the profile of brain injury management has been raised as a result. The team act as willing advocates for the future development of regional brain injury services across South Yorkshire.

Patient and relatives’ feedback to date has been excellent, but more development is needed. Future projects will look at developing out-patient capacity and community links.

The pathway has extended the role of rehabilitation into acute services and demonstrated the importance of actively supporting individuals and families at all stages of rehabilitation. Other centres are now looking at copying the service, and there is a real chance that it will become a standard model used to provide better brain injury services across the UK.

For further information please contact:

Julie Batterley, Clinical Nurse Specialist
Dr Rajiv Singh, Consultant in Rehabilitation Medicine

Phone number 0114 2266572 or bleep 445 via hospital switchboard

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