Discharge Management for Traumatic Brain Injury

Original Editor - Wendy Walker

Top Contributors - Wendy Walker, Naomi O'Reilly, Lucinda hampton, Kim Jackson, Rachael Lowe, Admin, Jess Bell, Tarina van der Stockt, Simisola Ajeyalemi, Uchechukwu Chukwuemeka and Rucha Gadgil  

General Principles of Good Practice for Discharge

Good discharge planning can make all the difference to the clients ongoing well being.

Discharge planning should involve, from the outset, the patient and their family/carers, and the rights and wishes of the patient should be listened to and respected.

If possible, it is considered useful that the discharge occur in the morning, providing the afternoon and evening hours for the individual to settle into their new environment before going to sleep. Earlier in the week is also better than a friday as many services me be out over the weekend.

For patients returning home, adaptations may need to be provided prior to discharge. The video below gives a brief look at the process.

Planning for Discharge

In many hospitals, there is a named professional who has overall responsibility for discharge planning.

A formal discharge meeting should be arranged, involving (but not limited to)

• patient
• hospital nursing staff
• medical social worker
• rehabilitation staff (including physiotherapist, occupational therapist, speech and language therapist if relevant)
• social services staff
• close family members and carers (if appropriate)

In some cases the person may be able to go on a trial visit home for a day and/or overnight before actually being discharged.

Information Provided on Discharge

The hospital should provide information on:

• Symptoms of complications that could require urgent treatment
• Activities to avoid, and for how long (eg. driving)
• Prescriptions and medications
• Cognitive changes which may be expected, and suggestions on their management
• Ongoing rehabilitation requirements
• Any special dietary requirements (eg. soft diet, or thickened fluids) if the patient has problems with swallowing
• Contact details for key professionals and all health providers involved when discharged
• If appropriate, details on how to manage incontinence/urinary catheter

NB It is important to check with client and carers/family they understand the process and feel comfortable with the arrangements.

Return to Work

People who have suffered mild to moderate TBI may be able to return to the work they were involved in before their brain injury. Return to work is an important measure of integration into the community. One author reports that individuals with brain injury who fail to return to work have a lowered subjective wellbeing when compared to those who succeed in returning to work.

Studies show that only 30% of people with moderate TBI and 80% of people with mild TBI successfully return to work, The image shows a workplace for the disabled in Vietnam.

Barriers to returning to work:

• Cognitive impairment
• Loss of motivation
• Fatigue
• Lack of support provided in the work environment
• Inadequate communication between medical professionals and the employer/manager with the result that the employer does not know how to support the person with TBI

Sequelae which commonly occur late in TBI, after Discharge

NOTE: for more information see Medical Complications in TBI page.

Below a few of the sequelae are listed

• Heterotopic Ossification This build up of new bone at the joint has been found to occur in between 10% and 20% of patients with moderate to severe TBI. The most common sites is the hip, followed by the elbow
• Post Traumatic seizures (which, in turn, causes further damage to the brain
  

• Bladder Bowel Dysfunction and Genitourinary Complications
• Nutritional Deficits
• Degenerative Brain Diseases and Dementia
• Mental Health Problems
• Pituitary Dysfunction. Pituitary dysfunction, leading to neuroendocrine dysfunction, is a recognised but potentially underdiagnosed complication of TBI[1][2]. It is often labelled Post-traumatic hypopituitrism. This can result in "neurobehavioural sequelae" including concentration difficulties, fatigue, anxiety and depression[3]. One  study[4] specifically looked at the time of onset of pituitary dysfunction, and concluded: "The risk of developing endocrine dysfunction after TBI increased during the entire 5-year follow-up period."

Resources

Headway have useful information about returning to work after brain injury.

The document Brain Injury; a guide for employers by Headway has detailed information on the topic.

Headway also produce information on Self Employment after Brain Injury and Voluntary Work after Brain Injury.

References

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