GOV-041227
Traumatic Brain Injury Residential Rehabilitation (TBIRR)
Service Overview Service Page v16.0
Summary
Objective
The TBIRR service supports Clients who have sustained a moderate to severe traumatic brain injury (TBI) who require high intensity,
comprehensive neurological rehabilitation, nursing and medical service in a specialist residential facility. The goal is to return these
Clients to active and meaningful participation in their community and, if appropriate, their place of work in a planned, timely, well sup-
ported and sustainable manner.
[Out of Scope]
Owner
Expert
Procedure
1.0 Traumatic Brain Injury Residential Rehabilitation - Contract and Operational Guidelines
a Below is the TBIRR Service Schedule (contract) for the period 1 April 2019 to 31 March 2024.
TBIRR Service Schedule
b Below are the Operational Guidelines for the TBIRR service for the period 1 April to 31 March 2024.
TBIRR Operational Guidelines
2.0 Early cover and admission to TBIRR facility
a DHBs will send the ACC45 Injury claim form and clinical information supporting the diagnosis within the first three days of the
client's admission
NOTE The DHB will undertake the following:
The DHB will diagnose the client's injury and assess the severity based on GCS, PTA and other clinical assessments.
The client will receive treatment and rehabilitation care which may include: surgery, intensive care, neurology, ortho-
paedic interventions. The DHB will also email the clinical information to enable ACC to make an early cover decision.
b ACC should make a cover decision within 2 days of receiving the information (preferably within hours)
c The DHB will also complete an ACC7422 Early cover application form and send it to the Early Cover Registration team. The
registration team will forward the referral to the appropriate team as soon as possible
ACC7422 Early cover application form
NOTE The ACC7422 Early Cover Form - more information
The ACC7422 Early Cover Form is completed by the DHB when a patient with a moderate to severe TBI, multi-trauma
or spinal cord injury requires an early cover decision so that ACC can assign a case owner who can contribute to dis-
charge planning before the Client's discharge from hospital
d Once allocated, the case owner should contact the ward as as soon as possible by telephone. The details of who to contact on
the ward can be found in Section 6. of the ACC7422 Early cover application form
e The case owner should offer to visit the ward and be an active participant of the multidisciplinary team and contribute to dis-
charge planning and ensuring services are in place for the client on discharge
f The DHB's medical specialist will assess whether the client meets the criteria of being medical stable before arranging for the
client to be transferred to the TBIRR facility
Medically stable means that the Client meets the following criteria
g The TBIRR supplier will also maintain contact with the acute services at the DHB and will be involved in the discharge planning
to minimise delays and to ensure that they are well prepared to receive the client into their services.
3.0 Rehabilitation programmes
a The TBIRR service comprises of three specialist rehabilitation services:
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Residential Rehabilitation (TBIRR) > Traumatic Brain Injury Residential Rehabilitation (TBIRR) Service Overview Service Page
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NOTE Emerging Consciousness
For clients who are in a minimally conscious state but are not in a coma. The aim of the programme is to return the
client to consciousness by providing high quality neuro-stimulation and care that preserves brain function and stimu-
lates a return to consciousness. Maximum stay is 90 days. Comprehensive rehabilitation, nursing and medical care is
provided.
NOTE Residential Rehabilitation
For clients who are conscious and able to actively participate in their rehabilitation. The aim of the residential rehabil-
itation programme is to support clients to return to participation in their community and, if appropriate their place of
work by providing personalised high quality, high intensity inpatient rehabilitation in a planned, timely, well supported
and sustainable manner. Maximum stay is 180 days.
NOTE Day Rehabilitation
For clients who are able to live in the community and able to travel to the rehabilitation facility on an outpatient basis.
The day programme provides high quality, high intensity outpatient rehabilitation to support clients to return to partic-
ipation in their community and, if appropriate their place of work. Approval and purchase order is required after 14
days. Maximum programme is up to 180 days.
4.0 Key Features of TBIRR
a The Service is focused on maximising client participation in their rehabilitation and their outcomes through the following key
features:
b Purchase orders are not generally required for the delivery of this service. This allows the Supplier to provide the required ser-
vices in a seamless way. However there are some circumstances where Purchase Orders are required.
Purchase orders and approvals
c Supported transitions
NOTE Supported transitions
TBIRR Suppliers visit the client while they are in acute care to prepare the client and the family for the admission into
the TBIRR facility.
While the client is in the TBIRR facility, the TBIRR Supplier, ACC and assigned community suppliers all work together
to ensure the client’s transitions into and out of the rehabilitation facility are timely, seamless and well supported. This
is achieved by starting the discharge planning as early as possible and having regular communication with all relevant
stakeholders.
d Interdisciplinary team
NOTE Interdisiplinary team
The supplier is expected to have a highly qualified rehabilitation team with significant experience in neurological
rehabilitation. The team is made of medical rehabilitation specialists, clinical neuropsychologists, psychologists, spe-
cialist nurses, occupational therapists, physiotherapists, speech language therapists, social workers, rehabilitation
assistants and any other professional considered essential to the client’s personalised rehabilitation programme.
The whole interdisciplinary team, the client and their family and any other community service providers are involved in
planning and guiding the delivery of the rehabilitation programmes. The case owner is an integral part of the team and
is kept informed about the client's progress and discharge planning.
5.0 Service Limits
a The service provides high intensity rehabilitation and as such the supplier is expected to achieve the maximum client out-
comes in the shortest time possible.
• Emerging consciousness programme – up to 90 days
• Residential programme – up to 180 days
NOTE What if the client who is minimally conscious requires care in the TBIRR facility for longer than 90 days?
If the TBIRR Supplier requests an extension of time for a minimally conscious client, the case owner should obtain
clinical advice. Clients who are not emerging to consciousness may require discharge to another facility.
NOTE What if the client requires longer than 180 days for a Residential programme?
The TBIRR Supplier may request an extension of time for a period of no longer than 14 days at a time. The case
owner may approve an extension for a maximum of 14 days and issues a purchase order. If a further extension of time
is required, the Supplier must request approval and purchase order is issued for a further extension of time up to 14
days
NOTE How long can a client stay in the out-patient day programme?
Clients may attend the day programme for up to 180 days. But after the first 14 days, case owner approval and a pur-
chase order is required.
ACC > Claims Management > Manage Claims > Service Pages > Specialist Care and Rehabilitation > Specialist Rehabilitation and Disability Services > Traumatic Brain Injury
Residential Rehabilitation (TBIRR) > Traumatic Brain Injury Residential Rehabilitation (TBIRR) Service Overview Service Page
Uncontrolled Copy Only : Version 16.0 : Last Edited Thursday, 23 January 2025 3:38 pm : Printed Wednesday, 23 July 2025 1:20 pm
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