The presence of a TBI can be a significant factor that affects long-term outcomes for people after serious injury. Scoping work in 2022 identified that, in Aotearoa New Zealand, assessment and identification of TBI in patients with major trauma was inconsistent. It is well understood that the duration of post-traumatic amnesia (PTA), as measured by a validated tool, is an important predictor of functional return and overall recovery. The sTBI rehabilitation collaborative worked with project teams from across the country to improve the rates and accuracy of PTA screening for major trauma patients to ensure that all patients with a TBI receive appropriate and timely rehabilitation.
sTBI rehab accordion
Extensive scoping work completed in the early stages of the project included regular meetings with the project’s expert advisory group, engaging with consumers with lived experience of TBI, conducting trauma team surveys, connecting with allied health professionals about current practice and visiting regional hospital sites.
This consultation identified that systematic screening of brain injury in patients who were admitted to hospital with major trauma were limited, particularly for people who did not lose consciousness (as measured with the GCS) or had a normal CT scan of the head.
In total, 55 percent of hospitals surveyed reported that trauma patients were discharged home without an appropriate head injury assessment; this was a moderate occurrence (one to three patients per month) in 25 percent of cases and a frequent occurrence (most weeks) in 30 percent. A total of 40 percent of hospitals reported that they had no systematic processes to identify trauma patients with a TBI. Screening for a brain injury was often challenging on weekends and after hours because of staff shortages and a lack of allied health professionals working.
The presence and duration of PTA is a well-known prognostic indicator of long-term recovery and return to functional independence. Severity of TBI is also based on duration of PTA. The TBI severity classifications as recognised within ACC criteria are:
- Mild TBI: GCS score 13–15; PTA duration <24 hours
- Moderate TBI: GCS score 9–12; PTA duration 1–6 days
- Severe TBI: GCS score 3–8; PTA duration ≥7 days
Ambitiously, the goals for this project are:
- Identification – systematic screening of all (major) trauma patients
- Assessment – completed PTA assessment on all identified patients
- Outcome – positive patient and whānau experience.
Two quality improvement approaches have been used in this work:
- co-design involving consumers to identify and understand problems and issues and to design and implement resolutions[1]
- working with local project teams to resolve problems and issues via a national collaborative.[2]
Footnotes
[1] Te Tāhū Hauora Health Quality & Safety Commission. 2023. The co-design process. URL: www.hqsc.govt.nz/resources/resource-library/the-co-design-process. Accessed 21 April 2023
[2] A collaborative involves bringing regional project teams together for three in-person learning sessions over the course of a year. The focus of these sessions is learning from each other and recognised experts in the topic area and learning quality improvement methodologies (tools and techniques). The teams take the learning ‘home’ and work on their projects between each learning session – known as the action period. Support during the action periods is provided by the national project team and peers through Zoom meetings, online forums and on-site mentoring visits. The end products/outputs are written summaries of the projects that others can learn from and replicate to resolve similar issues. (Institute for Healthcare Improvement. 2003. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: IHI.)
June–August 2022 (scoping phase)
- Regional site visits
- Trauma team survey
- Expert advisory group meetings
- Collaborative planning sessions
October 2022–March 2023 (collaborative wave 1)
Teams: Northland, Bay of Plenty, Taranaki, Hawke’s Bay, Dunedin
- Learning sessions, coaching calls and site visits
- Problem identification
- Generate and test
- Implement and sustain
- Learn and spread planning
February–June 2023 (collaborative wave 2)
Teams: Auckland, MidCentral, Nelson Marlborough, Christchurch
- Learning sessions, coaching calls and site visits
- Problem identification
- Generate and test
- Implement and sustain
- Learn and spread planning
The collaborative used the Institute for Healthcare Improvement’s breakthrough series collaborative model as an evidence-based methodology to support the teams. Projects were co-designed with patients and used robust processes to identify key problem areas and explore change ideas that were measurable within their services.
The sTBI collaborative has taken place over two phases. The first started in October 2020, and five hospital teams and finished in . The second phase commenced in February 2023 and ran through to June 2023 with four teams.
Phase one teams
Phase one teams:
- Te Whatu Ora – Health New Zealand Te Tai Tokerau Northland
- Te Whatu Ora – Health New Zealand Hauora a Toi Bay of Plenty
- Te Whatu Ora – Health New Zealand Taranaki
- Te Whatu Ora – Health New Zealand Te Matau a Māui Hawke’s Bay
- Te Whatu Ora – Health New Zealand Southern
Phase two teams
Phase two teams:
- Te Whatu Ora – Health New Zealand Te Toka Tumai Auckland
- Te Whatu Ora – Health New Zealand Te Pae Hauora o Ruahine o Tararua MidCentral
- Te Whatu Ora – Health New Zealand Nelson Marlborough
- Te Whatu Ora – Health New Zealand Waitaha Canterbury.
The serious traumatic brain injury collaborative produced the report Serious traumatic brain injury in Aotearoa New Zealand: Summary of improvement work in April 2024.
An introduction to sTBI rehabilitation workstream
Extensive scoping work completed in the early stages of the project included regular meetings with the project’s expert advisory group, engaging with consumers with lived experience of TBI, conducting trauma team surveys, connecting with allied health professionals about current practice and visiting regional hospital sites.
This consultation identified that systematic screening of brain injury in patients who were admitted to hospital with major trauma were limited, particularly for people who did not lose consciousness (as measured with the GCS) or had a normal CT scan of the head.
In total, 55 percent of hospitals surveyed reported that trauma patients were discharged home without an appropriate head injury assessment; this was a moderate occurrence (one to three patients per month) in 25 percent of cases and a frequent occurrence (most weeks) in 30 percent. A total of 40 percent of hospitals reported that they had no systematic processes to identify trauma patients with a TBI. Screening for a brain injury was often challenging on weekends and after hours because of staff shortages and a lack of allied health professionals working.
The presence and duration of PTA is a well-known prognostic indicator of long-term recovery and return to functional independence. Severity of TBI is also based on duration of PTA. The TBI severity classifications as recognised within ACC criteria are:
- Mild TBI: GCS score 13–15; PTA duration <24 hours
- Moderate TBI: GCS score 9–12; PTA duration 1–6 days
- Severe TBI: GCS score 3–8; PTA duration ≥7 days
Ambitiously, the goals for this project are:
- Identification – systematic screening of all (major) trauma patients
- Assessment – completed PTA assessment on all identified patients
- Outcome – positive patient and whānau experience.
Two quality improvement approaches have been used in this work:
- co-design involving consumers to identify and understand problems and issues and to design and implement resolutions[1]
- working with local project teams to resolve problems and issues via a national collaborative.[2]
Footnotes
[1] Te Tāhū Hauora Health Quality & Safety Commission. 2023. The co-design process. URL: www.hqsc.govt.nz/resources/resource-library/the-co-design-process. Accessed 21 April 2023
[2] A collaborative involves bringing regional project teams together for three in-person learning sessions over the course of a year. The focus of these sessions is learning from each other and recognised experts in the topic area and learning quality improvement methodologies (tools and techniques). The teams take the learning ‘home’ and work on their projects between each learning session – known as the action period. Support during the action periods is provided by the national project team and peers through Zoom meetings, online forums and on-site mentoring visits. The end products/outputs are written summaries of the projects that others can learn from and replicate to resolve similar issues. (Institute for Healthcare Improvement. 2003. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: IHI.)
Timeline of the sTBI rehabilitation workstream
June–August 2022 (scoping phase)
- Regional site visits
- Trauma team survey
- Expert advisory group meetings
- Collaborative planning sessions
October 2022–March 2023 (collaborative wave 1)
Teams: Northland, Bay of Plenty, Taranaki, Hawke’s Bay, Dunedin
- Learning sessions, coaching calls and site visits
- Problem identification
- Generate and test
- Implement and sustain
- Learn and spread planning
February–June 2023 (collaborative wave 2)
Teams: Auckland, MidCentral, Nelson Marlborough, Christchurch
- Learning sessions, coaching calls and site visits
- Problem identification
- Generate and test
- Implement and sustain
- Learn and spread planning
sTBI Collaborative
The collaborative used the Institute for Healthcare Improvement’s breakthrough series collaborative model as an evidence-based methodology to support the teams. Projects were co-designed with patients and used robust processes to identify key problem areas and explore change ideas that were measurable within their services.
The sTBI collaborative has taken place over two phases. The first started in October 2020, and five hospital teams and finished in . The second phase commenced in February 2023 and ran through to June 2023 with four teams.
Phase one teams
Phase one teams:
- Te Whatu Ora – Health New Zealand Te Tai Tokerau Northland
- Te Whatu Ora – Health New Zealand Hauora a Toi Bay of Plenty
- Te Whatu Ora – Health New Zealand Taranaki
- Te Whatu Ora – Health New Zealand Te Matau a Māui Hawke’s Bay
- Te Whatu Ora – Health New Zealand Southern
Phase two teams
Phase two teams:
- Te Whatu Ora – Health New Zealand Te Toka Tumai Auckland
- Te Whatu Ora – Health New Zealand Te Pae Hauora o Ruahine o Tararua MidCentral
- Te Whatu Ora – Health New Zealand Nelson Marlborough
- Te Whatu Ora – Health New Zealand Waitaha Canterbury.
Serious traumatic brain injury in Aotearoa New Zealand: Summary of improvement work
The serious traumatic brain injury collaborative produced the report Serious traumatic brain injury in Aotearoa New Zealand: Summary of improvement work in April 2024.
A 2024 review found that the sTBI collaboration has resulted in lasting service improvement initiatives.
The report “Serious Traumatic Brain Injury Collaborative progress report” details the analyses and outcomes from the review.
Read more about the Serious Traumatic Brain Injury Collaborative progress report
sTBI rehabiltation news
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Serious traumatic brain injury national collaborative concludes in Wellington
06 Jul 2023
The second phase of the serious traumatic brain injury (sTBI) national collaborative came to a close on Tuesday 13 June with the final learning session held in Wellington for the four participating teams.
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The Commission’s trauma programme improves health outcomes for New Zealanders after serious injury
13 Mar 2023
The Health Quality & Safety Commission trauma programme is a partnership with the National Trauma Network and the Accident Compensation Corporation, that aims to establish a contemporary system of trauma care in Aotearoa New Zealand.
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Serious traumatic brain injury (sTBI) national collaborative begins second phase of improvement work
01 Mar 2023
The second phase of the sTBI national collaborative launched on Tuesday 21 February 2023 with the first learning session in Wellington. This follows the first phase, which began in October 2022.
Published: 3 Aug 2023
Modified: 11 Feb 2025
