Methods Analysis of data on children receiving in-patient neurorehabilitation at a paediatric Regional Neuroscience Centre (RNSC), 2014-2018. Information concerning therapy provision was obtained from Trust Clinical Information System Suite (CISS). Patient dependency and rehabilitation complexity was assessed by Rehabilitation Complexity Scale-Extended (RCS-E), scored by multi-disciplinary team (MDT) at weekly meetings over 15 months. For modelling purposes, a specialist neurorehabilitation outreach tariff equating to 50% in-patient tariff was assumed. Data analysis was undertaken by linear programming model (XpressIve©) and Discrete-Even Simulation (Simul8©).Various eligibility criteria for outreach provision were modelled: 1) needing >1 therapies<3 times/week; 2) Total RCS-E score <9,<11 or<13; 3) Therapy Dependency (TD) +Therapy Intensity (TI) components of RCS-E <5.Results 156 children received neurorehabilitation as in-patients over 4 years. Mean age=7.34 years (range 0.1-17). 66 (55%) were male, 53 (45%) female. 84% had ABI, others acquired spinal injury, acute polyneuropathy or somatisation disorders. 52% lived >40 miles from RNSC, 47%>60 min' drive away. 49% were inpatients 1-28 days; 34%, 29-84 days; 18, 85-168 days; 6,>168 days. Patients showed significant functional improvements between admission to neurorehabilitation and discharge (p<0.001). Modelling suggests 14 outreach centres, including RNSC, would be required to permit 78% patients to access specialist neurorehabilitation <30 mins drive from home; 10 centres would permit 92% to access neurorehabilitation <45 min' drive away; 8 centres would permit 96% to access neurorehabilitation <60 min' drive away. Calculations assuming outreach tariff=50% in-patient tariff, and various RCS data models, suggest annual cost savings ranging from £53,424-£166,950; calculations based on CISS data, suggest average savings of £1 05 596 per year (range £98,500-£113,526). Conclusion Modelling supports the feasibility and affordability of specialist neurorehabilitation outreach provision, although efficacy remains uncertain.
AbstractsArch Dis Child 2019;104(Suppl 2):A1-A279 A27RAG approach ensured that all jobs were completed timely and appropriately, weekly reviews of the database helped ensure that the team was up to date with the pending jobs. There was improved staff satisfaction with the RAG approach. Conclusions The LTV team coordinates the care of children with complex respiratory issues and has high workload with varied issues including chasing pending results, organising investigations, starting medications and arranging clinical reviews. The RAG approach helped the LTV team to better organise the workload, pending jobs were completed timely and aptly and this improved both parental and staff satisfaction.