In the UK annually, over 40,000 children and young people sustain an acquired brain injury. Many of these children experience significant impairment and require rehabilitation as part of their care pathway.
Nationally, there is no standardised model for the configuration and delivery of paediatric neurorehabilitation services, with information scant regarding the impact on outcomes for children and their families. Therefore this project aimed to evaluate an innovative paediatric neurorehabilitation model ('BRILL', Brain Injury: Living Life) in the East Midlands in order to answer the following objectives:
- To establish if the BRILL service improves the quality of paediatric neurorehabilitation and reduces length of stay.
- To contribute to the evidence base of paediatric neurorehabilitation models.
- To identify areas where the BRILL service can develop and improve.
A process evaluation using a developmental perspective was used in line with Medical
Research Council (MRC) guidance on the evaluation of complex interventions.
Detailed description of the intervention and implementation and analysis of mechanisms of impact and contextual factors through analysis of routinely collected data and family, staff and
stakeholder feedback enabled the objectives to be met, the effectiveness of the service to be reviewed and recommendations for improvements to be made.
Data from the BRILL database from April 2017-March 2018 and length of stay (LOS) data
since October 2014 was included in the service evaluation.
Feedback was gathered from staff via an anonymous questionnaire and feedback forums with families and stakeholders.
Descriptive and inferential statistics were used to analyse the quantitative data from the
database. Qualitative data was analysed thematically.
A detailed description of the BRILL service in terms of its structure and processes is
Analysis of the demographics of the 2017-2018 cohort demonstrates the regional
reach of the service and wide variety of causes of ABI.
Analysis of the patient pathway revealed the majority of CYP are admitted from another East Midlands hospital to access regional specialist services. It also revealed some issues
regarding coding of inpatient episodes as these are not updated during the inpatient stay
when patients transfer medical specialty.
Analysis of routinely collected outcomes demonstrated the effectiveness of the service
model in that CYP functionally improved and their complexity of need reduced.
The LOS data analysis reveals the service is having a sustained impact on reducing LOS for this group of patients.
There is high satisfaction with the service from CYP, parents and
stakeholders, as collected via the service satisfaction questionnaire and feedback forums.
The BRILL service is meeting its objectives of improving the quality of paediatric neurorehabilitation and reducing LOS. This is demonstrated in the improvement in patient outcomes between admission and discharge, parent/patient satisfaction data and the qualitative feedback gained through the evaluation.
The service is having a sustained effect on LOS for this group of patients and continues to make significant cost savings, more than covering the cost of the service itself.
Needs and service gaps were identified by CYP, families and stakeholders which have been included in the recommendations for further service improvement.
This project was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM).
The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
This work was presented at Physiotherapy UK 2019 and presented as poster presentation at British Academy of Childhood Disability Annual meeting in March 2019 where it won best poster prize.