Impact case study database

The SASNOS has had a demonstrable and wide-ranging impact on clinical practice and patient care. The details surrounding this impact are outlined below:

Widespread National and International Adoption: The SASNOS is used by a diverse set of health professionals (e.g., Psychologists, rehabilitation staff, occupational therapists, nurses, and case managers) to guide care across all ABI treatment pathways [C1, C2]. It is also used in medico-legal practice for personal injury and clinical negligence litigation [ C1, C2], where it is helping to demonstrate the impact of NBD to inform the courts in relation to compensation payments. It has also been employed as a key outcome measure in research and clinical investigations in Australia, Denmark, and Bangladesh [C3].

The SASNOS can be obtained from a dedicated website and has been requested over 300 times since 2017 (a single request is usually made on behalf of multiple users/a whole service) [C2]. It is available in seven languages (English, Welsh, Spanish, French, German, Danish, and Bengali) and has registered users in at least 18 countries – UK, Australia, Canada, New Zealand, USA, Chile, Denmark, Bangladesh, Belgium, the Netherlands, Germany, Norway, India, France, Ireland, Spain, Switzerland and Sweden [C1 - C4]. For example, in 2017 the SASNOS was adopted by the only Brain Injury Clinic in Dhaka, Bangladesh. As the only such outcome tool available in Bengali, it is used with 90% of patients (~60-70 per annum) where it is helping to raise “ awareness among stakeholders” and “by showing a patient’s recovery visually/graphically” [C4].

The SASNOS has registered users from over 150 public sector services and private health providers in the UK alone, including over 60 NHS Trusts [C1]. Lancashire and South Cumbria NHS Trust (ABI service) use the SASNOS for goal setting and to ensure interventions are effective [C5] and Accomplish use it (>four years) to monitor progress and outcomes across their ABI residential services (~10 sites, ~80 beds) and to support those with ABI across their Dual Diagnosis and Supported Living pathways (>nine sites, 70+ beds) [C6]. Likewise, Ariya NeuroCare use the SASNOS to monitor rehabilitation progress across their residential, transitional, and community support services [C7].

Supporting Uptake via Training and Dissemination: Complementing instructional/training materials on the SASNOS website, an annual conference was launched in 2016 [C8] to provide training with the SASNOS and the assessment/management of ABI. Approximately 450 delegates have benefitted, with independent CPD accredited points awarded since 2018. Examples of delegate feedback include: “I have learnt a great deal today”, “Very useful – thank you very much!” and “SASNOS is a useful tool for exploring neurocog difficulties with staff and patents (particularly in groups where there is limited knowledge of the impact)”.

Filling Clinical Practice Gaps: Unique in its ABI specific design and aligned with contemporary models of neurorehabilitation, the SASNOS provides health professionals with the unique means to identify needs, plan, and monitor change. As reported by the lead for the Community Brain Injury Service at Abertawe Bro Morgannwg University Health Board, SASNOS “has filled a significant gap in that it has helped to better identify the less measurable but often more disabling neurobehavioral aspects of traumatic brain injury” [C9].

Responses from an international survey of SASNOS users (44 respondents from six countries, nine service types, and a range of professions) further highlights how SASNOS is meeting clinical needs [C2]:

• Australia - “Unlike other tools I've tried, the SASNOS allows for self-rating measures” (Clinical Neurologist, Public Sector).

• UK - “No other outcome measures are as effective at identifying the often-nuanced difficulties that ABI patients suffer in terms of CB [Challenging Behaviour]” (Assistant Psychologist, Private Sector).

• Australia - “It is a validated and standardised measure of NBD for ABI. We are unaware of any other measure that has established reliability and validity in this field” (Academic and Clinical Neuropsychologist, Public Sector).

• UK - “It gives a more accurate reading of the difficulties that my clients face on a daily basis” (Home Manager, Private Sector).

Benefitting Clinical Practice and Patient Outcomes: The SASNOS has demonstrably benefitted clinical practice, with the Clinical Director of Headwise reporting that it is “the only measure that captures the neurobehavioral legacies of brain injury which undermine social activity and participation, thus providing a unique basis for treatment planning and evaluation”. It “allows for more accurate clinical decision making, allows for a single metric to be adopted in a service rather than a multiplicity of tools, and helps our services to be more efficient in directing resources and more accurate in predicting outcome” [C10].

Large providers of neurorehabilitation have also invested considerable resource in using and integrating the SASNOS into their electronic patient record systems as a mandatory assessment. The lead Psychologist & Consultant Clinical Neuropsychologist for St Andrew’s Healthcare, who administers the SASNOS ~130 times per year (benefitting ~325 patients since 2011) reports - “I am not currently aware of another tool that could take its place and its level of integration within our service is now such that it is available to complete on the patient electronic record system” [C10].

Similarly, a third of all neurological cases and 100% of neurobehavioral pathway admissions at Elysium Neurological (>300 beds) are assessed with the SASNOS. Embedded into their electronic patient record and used to provide service level performance indicators, the SASNOS has increased confidence in care plans and enhanced their team’s clinical skills by educating them about the diversity/impact of NBD. In this way, the SASNOS has made a major contribution to risk assessment and management to ensure patient safety [C9]. Equipped to monitor change in NBD symptoms over time, clinical decisions are now informed by a reliable instrument rather than clinical judgement alone. Their Medical Director reports that “this is enormously important to us as a service as we need to confirm to patients, their families and commissioners that the rehabilitation we provide is effective and good value for money. Both are essential in helping us sustain our business as an effective and cost-efficient provider of rehabilitation services”. They conclude that the SASNOS “has resulted in us achieving better outcomes for patients than would otherwise have been the case” [C10].

Further examples of how SASNOS is benefitting clinical practice include [C2]:

• UK - “It [SASNOS] has proved a useful tool in educating and informing medical teams and other professionals that are not trained in neurology regarding neurobehavioral difficulties / impairments” (Occupational Therapist, Public Sector).

• Canada - “Helps show the areas where support is required, along with tools to show improvement” (Behavioural Therapist, Private Sector).

• UK - “Seeing whether the interventions we are putting in place have a positive outcome or not is very helpful” (Principal Psychologist, Private Sector).

Endorsed by Professional Bodies: Recognising its many benefits, the Independent Neurorehabilitation Providers Alliance (19 providers, ~58 clinical units) have recommended that the SASNOS is included in the UK Rehabilitation Outcomes Collaborative database [ S9], which is used by NHS England to inform funding models and to monitor outcomes and quality of rehabilitation. Importantly, the independent sector supplies ~70% of the 4,600 available beds for people requiring specialist neurorehabilitation – the NHS being the chief consumer [C11]. In 2018, the Professional Practice Committee of the Physical and Rehabilitation Medicine (this section of the EU Medical Specialists is 1,600,000 strong) also recommended the SASNOS for goal setting and assessment [C12].