A completed audit cycle and integrated care pathway for the management of depression following brain injury in a rehabilitation setting.
OBJECTIVE
To develop an evidence-based multidisciplinary integrated care pathway (ICP) for the management of depression following brain injury in a rehabilitation setting, and to assess its impact on standards of care and documentation.


METHODS
A regional rehabilitation unit providing inpatient rehabilitation for young patients (16-65) with complex disabilities mainly resulting from brain injury.


METHODS
A completed cycle of audit including: standards set for documentation, assessment, management and review; an initial retrospective audit of documented patient management against those standards during a five-year period (26 patient records); ICP development by a multidisciplinary team of doctors, psychologists and nurses based on clinical opinion and systematic review of the literature; re-audit from the ICP documentation (48 patient records) over a period of 15 months.


RESULTS
The initial audit demonstrated borderline acceptable documentation of baseline mood state and start of medication (54-61%), but poor documentation of review (29%) and subsequent treatment (27%). Introduction of the ICP improved all standards of documentation to 94-100%, except for assessment using a validated measure (84%) and follow-up assessment (76%).


CONCLUSIONS
This ICP raised staff awareness of depression, leading to improved documentation and possibly also standards of care.
Regional Rehabilitation Unit, Northwick Park and St Mark's Hospital Trust, Harrow, Middlesex, UK.
Nibras
N
Hassan
Lynne
L
Turner-Stokes
Katherine
K
Pierce
Frances
F
Clegg
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation*; D019091:Critical Pathways / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003866:Depressive Disorder / Q000209:etiology* / Q000523:psychology / Q000534:rehabilitation*; D004282:Documentation; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D006801:Humans; D008485:Medical Audit / Q000458:organization & administration*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D016730:Program Development; D011787:Quality of Health Care / Q000458:organization & administration*; D012047:Rehabilitation Centers / Q000458:organization & administration*; D012189:Retrospective Studies