Adelphi Centre for the Rehabilitation of Post-Comatose Patients with Severe Brain Injuries

Project location: ITALY, Rome
Project start date: December 2010 - Project end date: April 2011
Project number: 2010-70
Beneficiary: Roboris Foundation ONLUS

Interim Report II

Timeline of the present activity report:

From 04/01/2011 to 28/02/2011

During the period dating from 4 January 2011, through to 28 February 2011, activities centred primarily on the computer system for the management of individual rehabilitation programs and on work to a part of the building to provide privacy for patients and staff.

Given that the characteristics of the patients treated are especially complex, a computer system for the management of individual rehabilitation programs is required capable of preparing and memorizing individual rehabilitation treatment plans and printing reports for each patient. The system also needs to elaborate the input of the diverse medical personnel involved in patient treatment as well as keeping a track of the medical and physiotherapy appliances used.

It might be useful to focus on some of the programs which will be run on the computer system to support the work and activities of the Centre. However before doing so, to better understand the functioning of the system, it might be helpful to describe the treatment methods utilized at the ADELPHI Centre.

The intervention on the patient with Acquired Brain Injury (ABI) requires the putting in place of an individual program which takes into consideration the whole patient in distress.

This entails taking into account and intervening on a patient's damaged physical functions, psychological and behavioural problems, and the difficulties encountered in the areas of social interactions, relationships, and workplace reintegration, etc.

On a purely operational level, the ADELPHI Day Centre aims to combine rehabilitative health care with interventions in the areas of social interactions and relationships by putting into place measures to create a synergy between rehabilitation on the one hand and social and educational activities on the other.

The condition of patients with ABI is such that doctors tend to address first the patient's neurological and physical disabilities. To this end, a series of interventions is immediately initiated aimed at bring about the recovery of the patient; however psychological and behavioural problems, which often are a barrier to full recovery, will also be addressed.

The interdisciplinary team of professionals (which will operate on different levels of care for each ABI patient) will cooperate at all stages to evaluate and plan the intervention on the patient, to put into practice the operational programme and take part in the subsequent monitoring process.

The involvement of a patient's family is indispensable. The operating model of the Centre will be based also on the involvement of family members from the early stages of user input. This will allow for a joint programme to be put into place thanks to the sharing of treatment methods between all the professionals concerned.

It is vitally important that when a patient has been used to a certain amount of independence (compatible with his/her capabilities), he/she maintains this independence on leaving the Centre. It has often been noted that family members mistakenly tend to step in and act for patients in order to save them from undertaking physical and/or psychological exertions.

The Centre's computer system and the specific software it will run form an important part of this complex picture.

This software includes programs which will manage: "Patients' General Files"; "Rehabilitation Programs" and "Resource Reservations".

The program generating "Patients' General Files" provides for the registration, modification and printing of individual files containing:

- Past and present medical case history (illnesses, operations, tests, with the possibility of scanning documents brought in by the patient)

- Physiological history (problems, therapies)

- Results of physical examinations and body function assessments (with possibility of scanning documents)

- Medical history of patient (previous treatment periods at the Centre, tests, etc.)

Personal data of patients, family members, other contacts, etc. can also be registered and the relative files printed off.

Management of the extensive "Rehabilitation Programs" is the core of the computer system.

This program manages the:

• rehabilitation treatment plan assigned to each patient. The treatment plan is colour coded (Red, Yellow, Green), with each colour denoting the types of facilities (gymnasium, medical basin, occupational therapy unit, speech therapy unit) a patient is required to attend based on the medical condition to be treated and is defined by the number of "sessions" at each facility.

• compilation and printing of the rehabilitation treatment plan as well as brief reports of assessment team meetings (a group of doctors and physiotherapists who draw up the rehabilitation treatment plan and monitor progress)

• intermediate review and assessment of patients' progress with the possibility of adapting the individual plans when necessary

• patient's overall assessment at his/her discharge

While a patient is undergoing rehabilitation, the system can:

• register a patient

• define the facilities and resources which a patient needs to use based on predefined protocols but with the possibility of introducing modifications

• reserve facilities and resources for patients

• book a patient's period of attendance at the Centre.

The program which manages "Resource Reservations" allows users to access and reserve the services provided in the various rehabilitation facilities. It is the first important point of contact between the Centre and patients and their families. The quantity and the quality of the data to be treated, together with the necessity of providing timely and accurate information, has led to the selection of a computer system capable of efficiently managing the complex organizational needs of the Centre. Specifically, the system permits the scheduling of the various facilities (gymnasium, medical basin, doctors' rooms, etc.) and their assignment to the single operators (doctors, physiotherapists, etc.) The system's strength will lie above all in it's ability to manage a large number of different specialists with varying and changeable appointment schedules. The reservation of a facility and its assignment to a particular specialist will be facilitated by the use of a an intuitive and user-friendly computer system.

It will be fundamental to constantly monitor the quality of the services provided by the Centre in order to determine the level of success achieved. To provide an overall evaluation over various contexts, the computer system will be instrumental in quantifying:

• the standard of service provided, and its quality and effectiveness as perceived by end-users

• the professional development of the teams working at the Centre

• the standard of innovation of the technologies in use at the Centre

Quantitative and qualitative indicators will be adopted for each of these three contexts.

The work carried out to increase patient and staff privacy consisted of applying a special opaque film covering to the ground floor windows of the building to prevent patients in certain areas (the medical basin, changing rooms, surgery, occupational therapy room, etc.) being seen by passersby. In the medical basin room and the nearby changing rooms, a highly specialized film covering had to be utilized because of the elevated temperatures and steam present in these areas.