Bridging the gap of integration in specialist neurorehabilitation: development of the brain injury liaison coordinator role

The National Rehabilitation Hospital (NRH) is a tertiary level centre in Ireland providing complex specialist rehabilitation on a National scale. Waiting times for access to this centre are increasing in line with an increase in complexity for adults with an acquired brain injury. Current waiting times for those with a diagnosis of prolonged disorders of consciousness and challenging behaviour are over 12 months with little or no support at the acute or community level for patients waiting. Feedback from the acute setting seeking advice and support for patients waiting access to the NRH has resulted in a new role being developed with the aim of connecting and supporting local teams, patients and their families. A pre-admission outreach and liaison service has been developed which is currently filled by a senior neuro-physiotherapist. The role as it evolves primarily involves outreach and liaison visits to acute hospitals who are treating patients while they await access to the NRH. A visit is triggered by clinicians looking for support and advice in managing complex needs of patients. Visits can also be triggered by Rehabilitation Medicine Consultants following triage of a referral. The outreach visits involve liaison face to face with treating teams, assessment of the patient, joint treatment sessions with the treating teams, meetings with families and outside agencies e.g. disability managers, community brain injury services. In some cases the brain injury liaison coordinator has performed assessments for wheelchairs and positioning equipment. This has been triggered by the need to avoid the development of secondary complications like contracture in the absence of adequate equipment while awaiting access to the specialist centre. With increased communication between agencies it has allowed for a better understanding of the condition and what can be done while they await access to the tertiary centre. With a face to face meeting in the acute setting it has allowed for explanations on what to expect in the patient journey. It allows for a streamlined handover of advice and recommendations. It offers prompts for teams to begin applications for medical cards, housing adaptations or funding for long term care as appropriate. It also opens the channels for discussion about long term planning and the relevant brain injury services to engage. The role has allowed for earlier access to rehabilitation in current climate of increasing waiting times. It is complex case management that is individualised and patient centred. In some cases in conjunction with community brain injury services and the acute hospitals an admission to the NRH has been deemed not appropriate for the individual as it is felt that their needs would be better met in the more meaningful and contextual environment of home with rehabilitation services coming in. Overall with increased communication along the whole continuum of care and engagement in long term planning it has been observed that family expectations and distress are being managed. A new initiative is that the brain injury liaison coordinator has been meeting with the treating team and the family on admission to the NRH.