Increased physiotherapy capacity reduces duration of tracheostomy in situ, reduces hospital length of stay and improves functional outcomes for people with an acquired brain injury (ABI): a service review

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Abstract
To assess the impact of increased physiotherapy capacity in an acute regional Neurosurgery Centre on outcomes for people with an acquired brain injury (ABI) requiring a tracheostomy. A service review of patients undergoing active tracheostomy weaning, admitted over two 15-week time periods; normal physiotherapy staffing with enhanced physiotherapy staffing. With a 50% increase in staffing, physiotherapy rehabilitation sessions increased from 2 to 4 times weekly. A mean improvement was found for patient outcomes; time with a tracheostomy in situ reduced by 11 days and the length of hospital stay reduced by 19 days. Functional status on discharge also improved, with 33% of patients able to mobilise on discharge with normal staffing levels and 77% of patients able to mobilise on discharge with enhanced staffing levels. A temporary increase in physiotherapy capacity gave the opportunity to evaluate the impact on physiotherapy rehabilitation frequency and patient outcomes. Results demonstrate the positive impact for this complex patient group on outcomes including rehabilitation frequency, length of stay, time to decannulation, and functional status on discharge. Early access to high-frequency specialist physiotherapy rehabilitation is a critical component of improving functional independence in people with an ABI requiring a tracheostomy.IMPLICATIONS FOR REHABILITATIONIncreasing the capacity of specialist neurological physiotherapy treatment within this healthcare setting for people who have acquired a brain injury and require tracheostomy intervention may have a significant impact for patients and the NHS.Service improvement projects that use rigorous research methodology produce outcomes and evaluations that are robust and reliable.Supporting health and care professionals to use research methods within service improvement projects exposes them to the value of embedding research within their clinical environments.

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