Consultant physicians working with patients - Royal College of ...

2 Specialties Rehabilitation medicineservice quality include committed management,involvement of service users and regular audit.Inpatient unitThe BSRM recommends 45–65 beds per millionpopulation for specialist RM, depending on local servicepatterns for stroke and rehabilitation of older people. The minimum size of a viable inpatient unit shouldbe 20 beds, which should be located together tofoster rehabilitation nursing expertise. Space must be available for therapy, recreation,social activities, team meetings and case conferences. The unit requires immediate access to acute medicaland surgical services, dietetics and enteral feedingservices, and radiology and pathology services. Manual and powered wheelchairs must be availableon the unit, and there must be access to specialistorthotics and wheelchair clinics.Outpatient facilitiesMost patients need access to the MDT, as well asmedical clinics, so day assessments, case conferencesand outreach visits are often required. The RMconsultant will need access to services for: physiotherapy and hydrotherapy occupational therapy, including domestic facilitiesand workshops social services information technology (IT) equipment andsoftware for patient use orthotics and prosthetics specialist wheelchairs and seating electronic assistive technology driving assessment and training counselling and psychology sexual and genetic counselling education and employment training vocational rehabilitation.Work to maintain and improve the quality of careThe role of the RM consultant in leading servicedevelopmentsThe work of the RM consultant includes more servicedevelopment than that of most other specialists, as theylead or contribute to the development of care pathways –for example, the current development of major traumanetworks in England.Consultants in RM make major contributionsto productivity and quality (as exemplified in Englandby the Quality, Innovation, Productivity and Prevention(QIPP) programme). 12 Respiratory medicinereduces hospital usage by using preventive interventionsalongside general practice and community services, andby coordinating complex hospital discharges. Consultantsin RM could play a larger role given the increaseddrive to bring cohesion to rehabilitation services. 13Consultants in RM focus on maintaining and regainingemployment, 14 contributing to the agenda of theinterdepartmental strategy Health, work andwell-being. 15Consultants in RM lead undergraduate andpostgraduate teaching on disability andrehabilitation.Education, training and continuing professionaldevelopment (CPD)The training curriculum for RM 16,17 includesdeveloping skills in the management of neurologicaland musculoskeletal disorders and comorbidities arisingfrom multiple trauma or chronic immobilisation.Consultants must also have a thorough understandingof how individual and social behaviours influencedisability. Such training overlaps with psychiatry,neurology and neuropsychology. Training must deliverhigh-level skills in communicating with individuals andgroups, analysing complex situations and incorporatingpsychological elements in therapeutic interventions.The BSRM organises an annual programme of scientificmeetings, postgraduate courses and regionaleducational meetings. The scientific meetings of theSociety for Research in Rehabilitation are anotherimportant element in CPD.Clinical governanceClinical governance raises specific issues for RM, 18including the vulnerability of people with physical andcognitive impairments and medical accountability in anenvironment in which consultant roles may be obscuredby the multidisciplinary interagency context of RM.ResearchEvaluating complex interventions has been fundamentalin rehabilitation research for the past two decades,particularly in the development of outcome measures.Most evidence for the effectiveness of rehabilitationconcerns stroke, but evidence is emerging in acquiredbrain injury, MS and community-orientedC○ Royal College of Physicians 2013 207