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An Introduction to the Rehabilitation Codes used by BrainNav

The pathway flowchart and the rehabilitation codes used by BrainNav are based on the model developed by the Eastern Head Injury Group, and published by Pickard, Seeley, Kirker et al, in the Journal of the Royal Society of Medicine, August 2004.

This system gives each stage of the rehabilitation pathway a code number against which the type of rehabilitation input is defined, along with the patient needs that each code is designed to meet. The rehabilitation pathway is captured on a “Slinky” flowchart which is the basis for the BrainNav Flowchart used on this site.

The full coding system is shown below.

Code 05

Title Minor head injury inpatient management
Patient description Medically stable, requiring 24-48hrs observation prior to community rehabilitation, (as necessary in a small minority) with low probability of acute neurological deterioration requiring neurosurgical advice/transfer
Sites Acute A&E observation ward
Description of rehabilitation input
Assessment and observation – education, emotional and social support. Planned discharge home, sometimes with outpatient follow up or moves to code 30 at 48 hours

Code 10

Title Acute Supportive rehab (ASR1)
Patient description Medically unstable – requires neurosurgical critical care.
Sites Major Trauma Centre/ Trauma Unit
Description of rehabilitation input
Identifying and addressing early rehab goals

Code 20

Title Acute Supportive rehab (ASR2)
Patient description Medically unstable – requires general but not neurosurgical critical care.
Sites Major Trauma Centre/ Trauma Unit/Acute Hospital
Description of rehabilitation inputditto 10

Code 30

Title Rapid Access Acute Rehabilitation (RAAR)
Patient description Potentially medically unstable, but does not require critical care - unable to actively participate due to PTA, confusion, rejection, agitation, or low awareness state.
Sites Major Trauma Centre/ Trauma Unit/Acute Hospital
Description of rehabilitation input
Needs inpatient care and treatment, and environmental and behavioural management, for physical dependency and confusion, and continuous clinical assessment (nursing, medical, therapy) to detect deterioration and prevent avoidable complications, and to facilitate optimal timing of rehab input and referral to next rehab programme.

Code 40

Title Active participation in-patient rehab
Patient description Medically stable, able to actively participate with and benefit from therapy.
Sites Level 1: Regional specialized centre Level 2: Local specialist centre, Acute or community hospital
Description of rehabilitation input
Needs in-patient care due to physical dependency, or the need for specialist therapy equipment, a safe environment, supervision, or intensity of therapy, in a unit with the expertise and experience in rehabilitation of a condition (Level 1)which cannot be provided in a local specialist centre or in the community (Level 2) which cannot be provided in the community.

Code 50

Title Behavioural rehab
Patient description Medically stable, but prolonged confusion, amnesia or behavioural difficulties, requiring specialist behavioural management, intensive supervision and secure environment
Sites Specialist in-patient unit
Description of rehabilitation input
Specialist behavioural management, including high staffing: patient ratio to ensure intensive supervision and secure environment. Access to neuropsychology and neuropsychiatry

Code 60

Title Slow stream rehab
Patient description Medically stable, but low awareness or response persists beyond eg 3 weeks after sedation withdrawn, ICP corrected and medically stable. Able to benefit from medical and physical therapy to prevent complications and support recovery
Sites Community hospital or specialist in-patient unit
Description of rehabilitation input
Assessment/active rehabilitation phase which needs to be distinguished from long term care, although planning care increasingly important aim after some (eg 6) months. Patients may go to active participation unit if they improve sufficiently.

Code 70

Title Community rehab
Patient description Medically stable, able to actively participate with and benefit from therapy. Will include spectrum of initial severity of injury with a small minority derived from Code 05 category
Sites Domiciliary or day hospital
Description of rehabilitation input
Interdisciplinary co-ordinated management therapy aimed at community re-integration/inclusion by enhancing independence, wellbeing, & assist return to work/education. In collaboration with Social Services, neuropsychiatry, voluntary and statutory services. Includes treatment of patients in their own homes, or with live-in carers.

Code 75

Title Transitional Rehabilitative accommodation
Patient description Medically stable, requiring supportive environment/ accommodation, able to actively participate with and benefit from therapy. Will include spectrum of initial severity of injury with a small minority derived from Code 05 category
Sites Residential Care/Supported Housing
Description of rehabilitation input
Retraining and enablement in day-to-day domestic and community-based tasks in a non-hospital, home-like environment, aimed at community re-integration/ inclusion by enhancing independence, wellbeing, & assist return to work/ education. In collaboration with Social Services, neuropsychiatry, voluntary and statutory services. Help for family/carers in supporting the person in these roles, and with identifying statutory support available.

Code 80

Title Intensive psychological rehab
Patient description
Sites Medically stable, independently mobile, primarily cognitive impairments likely to benefit from intensive neuropsychological therapy
Description of rehabilitation input
Interdisciplinary, holistic and intensive assessment and therapy programme – addressing individual cognitive, social, emotional and physical needs, with the aim of a return to work, studies or independent community life.

Code 85

Title Brain injury clinic
Patient description Medically stable after any severity of head injury, but experiencing problems in the community with any combination of cognitive, emotional, behavioural or physical problems
Sites Outpatient clinic – acute or community hospital or other community location
Description of rehabilitation input
Multidisciplinary diagnostic and triage clinic, including expert medical input, with specialist brain injury nurse and/or neuropsychological assessment and support and follow-along available. Education, emotional and social support, both for patient and family. Liaison with/advice to GP and employer.

Code 90

Title Vocational rehab
Patient description Medically stable, living in community, aiming to enter/return to employment
Sites Domiciliary, community-based or residential
Description of rehabilitation input
Interdisciplinary programme addressing all aspects of occupational activity, including, specialist assessment, work preparation, job search, job coaching and workplace support, and employer/college education and support.

Code 100

Title Lifelong Maintenance Rehab
Patient description Medically stable, but permanent disability
Sites Domiciliary, residential/N.home, respite unit
Description of rehabilitation input
Life long prevention of avoidable complications involving residual physical, cognitive, emotional and behavioural problems, on a domiciliary, outpatient or respite basis.

Code 105

Title Specialist ABI Nursing Homes
Patient description Medically stable. Unable currently to live in the community.
Sites Residential Nursing Home
Description of rehabilitation input
Provide comfortable and stimulating environment, with encouragement to pursue recreational activities and personal interests. Would include daily activity programme and outside visits. Rehabilitation facilities could possibly include cognitive and behavioural support. Experienced nursing and care staff available 24 hours a day. Support with diet & feeding where necessary. Family members involved and consulted.

Code 110

Title Advice, information and Advocacy
Patient description Carer support from initial injury, patient support when able to communicate
Sites All sites
Description of rehabilitation input
Information and guidance over a continuum. Family support and outreach. Advocacy

Code 115

Title Support at home/in the community
Patient description Medically stable. Able to live in the community alone or with others.
Sites Clientʼs home/the community
Description of rehabilitation input
Enablement, support and care to develop social skills, stamina, confidence, attention & leisure pursuits, sorting out benefits, day supervision & respite care. Specific attention paid to Community involvement & integration (further education etc), Personal social development and empowerment and structuring activity towards achieving goals. Includes support that may be purchased with a personal budget.

Code 120

Title Community activity
Patient description Medically stable. Wanting to engage further with the community, alone or with others.
Sites All sites
Description of rehabilitation input
Organised activity in the community offering opportunities to to develop social skills, stamina, confidence, attention & leisure pursuits, Specific attention paid to: Community involvement & integration (further education etc), Personal social development and empowerment Structured daytime activity within the individualʻs competency framework. Includes Day activities, Day Centres, clubs and activity that may be purchased with a personal budget.

Code 125

Title Voluntary activity
Patient description Medically stable. Wanting to engage further with the community, alone or with others.
Sites All sites
Description of rehabilitation input
Organised activity in the community offering opportunities to develop skills through voluntary work and activity.

Code 130

Title Mobility/transport
Patient description Medically stable. Wanting to engage further with the community, alone or with others.
Sites All Sites
Description of rehabilitation input
Services that assist people with disabilities to travel in their local community or further afield.

Code 135

Title Equipment/Assistive technology
Patient description Medically stable, continuing disability.
Sites All sites
Description of rehabilitation input
Providing practical/ technological solutions to challenges and limitations imposed by cognitive, behavioural and physical disability.

Code 140

Title Case Management
Patient description Carer support from initial injury, patient support when able to communicate
Sites All Sites
Description of rehabilitation input
Assessment, guidance, management of care and support and rehabilitation needs; involving close liaison/working with the family.
See http://www.ehig.org.uk/pdf%20documents/Reprint%20of%20mapping%20paper.pdf for the original paper.

BrainNav also shows the NHS National Minimum Data Set codes for rehabilitation services shown below.

TERTIARY SPECIALISED REHABILITATION SERVICES – provided at regional/national level
Level 1:
Specialised rehabilitation services
Provided by specialised rehab teams led by consultants trained and accredited in the specialty of rehabilitation medicine (RM) (and/or neuropsychiatry):
Serving a regional or supra-regional population and taking patients with Category A needs – ie, severe physical, cognitive communicative disabilities or challenging behaviours, with highly complex rehabilitation needs* that are beyond the scope of their local specialist rehabilitation services, and have higher level facilities and skilled staff to support these. Collect and report full National Specialist Rehabilitation Dataset
Catchment: 1-3 million

Predominantly highly complex caseload (eg 60-70% patients with RCS score > 10)
LOCAL REHABILITATION SERVICES – provided at district level
Level 2:
Local (district) specialist rehabilitation services
Provided by inter-disciplinary teams led/supported by a consultant in RIVl, and meeting the BSRM standards for specialist rehabilitation services
Level 2a:
Led by consultant in RM. Serving an extended local population in areas which have poor access to level 1 services. Take patients with a range of complexity, including Category B and some Category A with highly complex rehabilitation needs* Collect and report full National Specialist Rehabilitation Dataset
Catchment: 600K-1 million

Mixed case load (eg SO% RCS score > 10)
Level 2b:
Led/supported by a consultant in RM. Serving a local population, predominantly patients with Category B needs. Collect and report at least the minimum national dataset
Catchment: 2S0-S00K

Less complex caseload (eg 20-30% RCS score > 10)
Level 3:
Local non-specialist services.
Includes generic rehabilitation for a wide range of conditions, provided in the context acute, intermediate care and community facilities, or other specialist services (eg, stroke units)
Level 3a:
Other specialist services led or supported by consultants in specialties other than RM – eg services catering for patient in specific diagnostic groups (eg, stroke) with Category C needs. Therapy/nursing teams have specialist expertise in the target condition
Level 3b:
Generic rehabilitation for a wide range of conditions, often led by non-medical staff, provided in the context acute intermediate care and community facilities for patients with Category D needs

These are still being developed further and more information can be found here:
http://www.bsrm.co.uk/ClinicalGuidance/Levels_of_specialisation_in_rehabilitation_services5.pdf
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