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.
Hassan
Nibras
N
Regional Rehabilitation Unit, Northwick Park and St Mark's Hospital Trust, Harrow, Middlesex, UK.
Turner-Stokes
Lynne
L
Pierce
Katherine
K
Clegg
Frances
F
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