Background
Research has demonstrated the importance of a patient-centred, interdisciplinary approach to shared decision-making in goal setting within rehabilitation, enhancing personalised care, reducing risks, and aligning treatment with patients’ needs. This approach promotes safer healthcare environments, increases patient motivation, and improves rehabilitation outcomes. The National Rehabilitation Hospital implemented a new goal-setting process to optimise patient care in specialised rehabilitation services in 2023. This study aimed to examine staff perceptions of the process, comparing differences between its initiation (T1) and one year post-implementation (T2), to assess its impact on care delivery and outcomes.


Approach
This study employed a mixed methods approach to explore staff experiences and perspectives on the implementation of a new patient-centred goal-setting process at its initiation (T1) and one year post-implementation (T2). Quantitative data were collected to assess staff attitudes, interdisciplinary collaboration, and evaluate the integration of the new process into routine practice. In addition, in-depth interviews were conducted to gain further insights into staff-perceived enablers, barriers, and the impact of the goal-setting process on patient care and teamwork across various rehabilitation specialties. Quantitative data were analysed using t-tests, while qualitative data were analysed using thematic analysis.


Results 
In T1, 56 staff completed the survey, with 61 participating in T2. Results showed a slight increase in staff confidence and optimism between T1 and T2, alongside a significant decrease in team inclusion (from 87.5% to 75.4%, p < .05). Staff considered the process sustainable at both time points, with sense-making scores rising from 3.40 to 3.73. For the qualitative study, 15 staff members were interviewed in both T1 and T2, revealing mixed findings: at T1, staff viewed the process as positive and collaborative, though some felt it added to their workload and pressure. By T2, staff remained motivated, recognising the process’s benefits for patient care, though concerns about resources and team adaptation persisted.

Implications
Implementing quality improvement activity in a healthcare organisation, even though the participants see its value, is a difficult undertaking. The study identified staff experience of the implementation journey of this new goal setting process. Results illuminate challenges and strategies to implementing changes to goal setting within rehabilitation context. Findings will be used to inform implementation of other quality improvement activities within the hospital and further contribute to knowledge for rehabilitation practice. 

Background: People with PD experience decreased balance ability and gait speed, but on-site training which has been proven effective is not feasible to patients with transportation barriers. Home-based telethealth has grown rapidly since the COVID-19 pandemic and has shown effectiveness in improving gait and balance in this population, but most interventions required expensive equipment or prolonged training periods, therefore our study aimed to explore the effects of a short-term exercise program delivered through simple digital devices and determine if such treatment could produce similar results to a short-term hospital based exercise program.

Approach: We recruited 13 patients (63.4±8.1 years old) to a five-week telehealth program which was addressed through networking apps. Participants were first given video links to the exercises which consisted of 25 minutes of dynamic movement training and 25 minutes of core muscle training. During the study period, participants interacted with a physical therapist through networking apps as scheduled, who would adjust the exercise intensity by giving feedback and by sending new video links leading to the exercise as appropriate. For the hospital based training, 13 age-mated patients (64.7.5±5.2 years old) were recruited to receive 25 minutes of dynamic movement training and 25 minutes of core muscle training led by two physical therapists twice a week in the hospital. Balance and gait were assessed in both groups before and after intervention by applying the Mini Balance Evaluation Systems Test (Mini-BESTest) and the 10-Meter Walk Test (10MWT). Statistical difference between groups pre- and post-training was determined using a two way repeated measures ANOVA, with a significance level set at p<0.05.


Results: Both balance and gait parameters improved in both groups, but the telehealth group only showed significant differences in balance (Mdiff=3.31±2.96, p=0.002), while the hospital group showed significant differences in balance (Mdiff=3.54±3.33, p=0.002) and in gait parameters (Mdiff=0.14±0.21, p=0.033) before and after training. However, there was no significant differences on the Mini-BESTest total score and 10MWT between the two groups.

Implications: The results indicate that both short-term exercise programs delivered through telehealth or in the hospital significantly improved the balance ability of PD patients. Although significant improvements in gait speed was observed in the hospital training group, the gait speed of the telehealth group also improved. These findings suggest that a remote short-term exercise program can be delivered at home and bring forth results similar to on-site training regarding balance and gait speed, and can serve as an option in future healthcare treatment in PD patients.

Learning Health System (LHS) aims to continuously integrate clinical data and patient outcomes to enhance care quality, efficiency, and patient experience by leveraging real-time data and fostering a culture of shared learning. Following its relocation to a state-of-the-art facility in 2020, the National Rehabilitation Hospital (NRH) presents a unique opportunity to embed LHS concepts into its rehabilitation services. This transition also provides a critical moment to explore interdisciplinary team (IDT) dynamics, decision-making practices, and collaborative frameworks, all aimed at improving team effectiveness and patient outcomes.

LHS principles promote the integration of research, clinical practice, and data analytics to create a feedback loop for continuous care improvement. In rehabilitation settings, the adoption of LHS can lead to more personalised, patient-centred care by facilitating collaboration within IDTs. NRH has embraced this approach, aligning with the LHS model to deliver holistic, adaptive, and data-driven care.

Research team conducted a scoping review, and four themes were identified for implementing an LHS in rehabilitation settings as, 1) Creating a functioning data infrastructure, 2) Ensuring data quality, 3) Assembling a multidisciplinary team, and 4) Addressing institutional characteristics such as communication and organisational learning. To make our LHS framework more actionable, research team presented the results of this scoping review and asked over 40 healthcare professionals and researchers to prioritise them during a workshop at ICIC 24.

Current presentation initiates three work packages (WPs) for exploring the implementation of LHS concepts at NRH. WP1 involves consultation with staff through a World Café process, gathering insights from healthcare staff to develop the roadmap of LHS. WP2 focuses on co-design workshops with working groups to define LHS goals, integrate patient-centred care, and establish an implementation strategy. WP3 will continuously evaluate the impact of LHS on rehabilitation services at NRH, ensuring iterative refinement and learning across the hospital.

The LINK project will contribute valuable insights into how LHS principles can transform rehabilitation care, fostering a culture of continuous improvement, patient engagement, and interdisciplinary collaboration.

Background
Cardiac rehabilitation (CR) is an evidence-based and cost-effective intervention that helps patients manage their own condition in partnership with their healthcare professionals. Cardiac rehabilitation has consistently been demonstrated to significantly reduce morbidity, hospital admissions and mortality amongst patients with established cardiovascular disease(1-6) while also increasing their quality of life.(7,8)

The Model of Care for Integrated Cardiac Rehabilitation in Ireland was published in October 2023 heralding a new integrated approach to care delivery. To support implementation, an in-depth review of current national hospital and community CR services was completed to identify the resources, supports and staff training required.
Methodology
Under the governance of the Prevention Sub-Group of the National Heart Programme Clinical Advisory Group, a survey of all 63 cardiac rehabilitation services within the Irish public health service was conducted. The survey contained 41 questions on the following topics in relation to CR: phases I, II and III, referral processes, waiting times, documentation, staffing, staff training, service audit and evaluation, discharge processes, plus a site’s perceived barriers and enablers to the delivery of integrated cardiac rehabilitation within their service.
Results
The results demonstrate a crisis in current CR services within the Irish public health service and highlight areas for improvement:
• A 38% reduction nationally in cardiac rehabilitation staff between 2009 and 2024.
• A 61% reduction in hospital cardiac rehabilitation staff between 2009 and 2024.
• There is significant variation among recently established community CR sites in terms of readiness to deliver CR: 14 of 30 sites were not delivering a Phase III CR service at the time of the assessment.
• Waiting times for Phase III initial assessment varied from 2-96 weeks, with median minimum and max waiting times of 4 and 16 weeks.
• There is a lack of standardisation across all components related to service delivery, including the referral process and ability to offer patient choice; structure of Phase III; delivery of core education components; documentation e.g. operational templates and patient information resources; and activity audit and evaluation.
Implications
• Identify national strategic support to address staffing deficits in cardiac rehabilitation (CR).
• Develop a standard national, evidence-based, quality-assured, person-centered CR program for Ireland.
• Deliver the CR program through in-person, online, or blended methods.
• Support ongoing development, evaluation, and training at local, regional, and national levels.
• Ensure sufficient resources and support for the successful implementation of integrated working in CR.
• Promote equitable access to CR services across Ireland.

References available on request.

Background:
Traumatic injury is a public health problem of enormous magnitude; it can be measured by years of productive life lost, prolonged or permanent disability, or financial cost. The optimal care of patients with traumatic injuries requires a coordinated and integrated system of trauma care.1 Improvements in outcomes for patients can be achieved by providing patient-focused and planned trauma care.

Approach:
The Inpatient Trauma Service (IPTS) was established in June 2023 with the aim of co-ordinating the care of the trauma patients upon presentation to hospital and aims to expedite their journey to recovery. The IPTS is a consultant-led multidisciplinary team in the MTC which integrates acute trauma teams with a dedicated trauma multidisciplinary rehabilitation team.

The IPTS identifies injuries, coordinates acute care, assesses rehabilitation needs and delivers acute rehabilitation, and provides timely onward referral to post-acute rehabilitation services. In conjunction with patients, the team created a patient “Trauma Recovery” booklet which is used for each patient to describe each individual’s injuries and supports them through their journey to recovery in a patient-centred approach.

Data was analysed from the first year since the establishment of the IPTS.
Outcome measures used include: Standards based on the UK National Clinical Audit for Specialist Rehabilitation following Major Injury (NCASRI) Patients who are thought to have complex needs for rehabilitation should be assessed within 10 days of referral and transferred to specialist rehabilitation within 6 weeks of being fit for transfer.
The rehabilitation complexity scale (RCS-e) was used to measure the complexity of rehabilitation throughout the patients stay in the major trauma centre.

Results:
100% of patients with complex rehabilitation needs were assessed within 10 days of referral.
There was a reduction in RCS-e from admission to discharge from the MTC.
No patients requiring post-acute complex specialist inpatient rehabilitation services were admitted within 6 weeks and many of them received this in an acute setting. Patients can wait 6-18 months for specialist services.
Patient’s have positively responded to the introduction of the patient Trauma Recovery booklet describing it as ‘empowering,’ ‘pivotal,’ ‘reassuring’.

Implications:
The IPTS has a proactive approach to identification of rehabilitation needs following a trauma, early intervention reducing rehabilitation complexity, and ensures the patient is referred to appropriate services.

The enhancement of acute trauma rehabilitation has impacted patients by orchestrating seamless care within the major trauma centre. The establishment of the IPTS team has allowed for the objective measurement of rehabilitation needs of trauma patients which can better inform the future phases of Ireland’s trauma network strategy to achieve integrated trauma care after the patient leaves the major trauma centre.
There is a need for post-acute, regional and community rehabilitation, to enable patients to achieve their maximum functional potential and receive integrated trauma care throughout the continuum of their trauma recovery journey.

• Background: In October 2023 we were approached by our local Integrated Care Board to host 2 slow stream beds at our 33 general bedded inpatient rehabilitation unit as a pilot. Our commissioned standard length of stay is 14-21 days, however it was felt within our locality there was a need for an alternative longer length of stay inpatient pathway for more complex patients.
• Approach: We involved our local acute hospitals, local discharge hubs, social services, our clinicians, and our local integrated care board in the implementation of this pathway. This consisted of staff surveys as well as meetings. Following initial consultation, we implemented the pathway relying on referrals from the acute hospitals and discharge hubs. During the pilot we gathered feedback from clinical staff involved with the pilot, social workers, and patients themselves. This comprised of staff surveys, team discussions, case studies and patient feedback, stories, and interviews. Patients input on the design of the pathway helped us shape and change the pathway in different ways. For example, following feedback we created alternative methods to accept patients onto this pathway. We identified patients already on our standard pathway, and converted them onto the slow stream pathway. Based on feedback we allowed our clinical screener, who screens all referrals to the unit, to identify appropriate patients. Staff satisfaction also increased during this pilot, due to staff being able to utilise their skills and being able to see bigger functional improvements in patients. Following the initial 1 year pilot we engaged with all stakeholders where we agreed to continue this pathway.
• Results: We had 12 patients on this pathway since October 2023. 9 have been discharged and three are currently on the pathway, with a further 4 currently on a waiting list. The average length of stay of these patients is currently 6-7 weeks. We realised an annual saving based on the 9 patients discharged (as opposed to if they did not come on this pathway) of approx. £500,000. All our patients achieved functional gains, increased independence, increased quality of life and were able to return home on discharge. 100% of patients returned home and 100% of patients remained at home 30 days following discharge. We used the Functional Independence measure, staff and patient feedback, patient stories, 30 day re-admission rates, discharge destination and follow up care needs to measure the impact of the pathway.
• Implications: This pathway shows the need in our locality in Northwest London for a slow stream inpatient rehab pathway. We have presented this to senior management and our local integrated care board have been able to increase our beds on this pathway from 2 to 4 (doubling our offer) as of November 2024. We are aware of another local rehab unit that is now piloting a slow stream pathway with 3 available beds, that are all utilised. We hope to continue to be flexible with our approach and ideally have a service with a multidisciplinary led approach to estimated discharge dates.