TBI Guideline implementation focussed on improving care, best use of resources

A year after the release of the INESSS-ONF Clinical Practice Guideline for the Rehabilitation of Adults with Moderate to Severe TBI (the Guideline) the nuts and bolts of implementation planning are almost complete. Working with key stakeholders, the Ontario Neurotrauma Foundation (ONF) has focussed on determining which of the 109 recommendations have priority and be achievable within the existing funding and resource envelopes currently available for rehabilitation programs across the province.

Released by the ONF and the Institut national d’excellence en santé et en services sociaux (INESSS) the Guideline covers all rehabilitation considerations following a TBI starting with rehabilitative care including the physical, sensory, cognitive, behavioral and emotional components as well as associated conditions such as behavioral, mental health and addiction issues.

“We have undertaken a broad consultation and received input from six acute care centres and 14 rehabilitation sites across the province,” says Judy Gargaro, ONF Implementation Associate. “Every site was asked to rate themselves on their progress against all 109 recommendations, we provided everyone with a summary of their own responses in the conLogo_eng_web_inessstext of the provincial results.” In particular, sites were asked to identify any internal barriers beyond staff time that might impact on their ability to improve rehabilitative TBI care.

The results of this outreach have been very encouraging with most sites reporting progress in key areas or noting that plans are in place to adjust clinical practices based on the Guideline.

ONF is now applying an implementation science approach to support effective and sustained changes to support care recommended in the Guideline. Survey results indicate there is particular interest in having ONF drive system-level priorities such as collaborative approaches to mental health, substance use and behaviour disorders, as well as establishing consistent approaches to discharge planning including communication and clear protocols and follow-up with every patient.

“While we will be happy with short-term ‘wins’ the long-term picture is very important. It would be great to see a report card on TBI care, for instance,” says Judy. “The Guideline offers a framework for change that will improve care and make better use of the resources devoted by each site to TBI rehabilitation.”