A completed audit cycle and integrated care pathway for the management of depression following brain injury in a rehabilitation setting

Abstract

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. Setting: A regional rehabilitation unit providing inpatient rehabilitation for young patients (16–65) with complex disabilities mainly resulting from brain injury. Methods and design: A completed cycle of audit including: standards set for documentation, assessment, management and review; L 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.