Standards for High Quality Post-Concussion Services and Concussion Clinics
The term “concussion clinic” in the standards below refers to the interdisciplinary care that will be required by the minority of patients who experience persistent symptoms post-concussion. The clinic can exist in one location, or as a formal coordinated network of healthcare providers.
Every patient who sustains a concussion should be assessed by a qualified practitioner able to make a diagnostic decision (physician, nurse practitioner, or neuropsychologist).
Post-concussion care and concussion clinics should have direct access to a physician with experience in concussion management to provide ongoing involvement regarding medical stability, trajectory of care, need for medical speciality referral and decisions on clearance to return to activity. (This can be provided through a physician working in a clinic or a physician associated through a formal arrangement.)
Individuals with concussion should have access to care at the following time points, according to the attached pathway.
T1: as soon as it is recognized that the individual has incurred a suspected concussion.
Education, resource information and follow-up:
T1: at diagnosis
T2: at 1-2 weeks when follow-up occurs
|T3:||at 3-4 weeks when flagged for further assessment and symptom management follow-up occurs.|
T4: in an ongoing fashion as symptoms are monitored through follow-up
|T5:||upon referral to an interdisciplinary concussion clinic and in an ongoing fashion through involvement with the clinic.|
Therapies and interventions once symptoms are deemed persistent
T5: upon referral to an interdisciplinary concussion clinic
Healthcare providers and concussion clinics should provide the following information and respond to the following questions/needs of the patient and family:
- About concussion and the trajectory of recovery
- Additional resources and information
- Healthcare provider experience
- Services offered
- Types of referrals available
Every patient diagnosed with concussion should receive follow-up (usually from his/her primary care provider) within 1-2 weeks.
A person treating patients for concussion symptoms should be a regulated health care professional, licensed by a regulatory body under the Regulated Health Professions Act, 1991; and the Social Work and Social Service Work Act, 1998, who:
- has had training involving direct patient care/contact and knowledge of traumatic brain injury and its biopsychosocial effects;
- has experience in concussion management with a high volume of patients with concussion annually; practices according to the most up-to-date, evidence-based guidelines;
- practices within their defined scope of practice and recognizes when to refer to other interdisciplinary providers as patient symptoms require.
A concussion clinic or network of providers should offer/utilize an interdisciplinary team with varying scopes of practice, with a minimum of three (3) or more different regulated health care provider disciplines.
A concussion clinic or network of providers should clearly outline for patients whether it is able to provide the full spectrum of care from initial management to longer term management of persistent symptoms (if required).
A concussion clinic or network of providers should have the following core functions/services in place to manage patients comprehensively and provide the best post-concussion care:
- Diagnosis and medical treatment decisions
- Physical treatment
- Cognitive, functional, emotional support
- Coordination of care function
Concussion Clinic teams and networks should delineate each other’s roles and professional scopes of practice.
A concussion clinic or network of providers should follow practices and use treatments that are evidence- based or recommended by provincial, national or international guidance or consensus statements.
Primary care practitioners, concussion clinic teams/networks of providers should follow referral indicators to refer patients to appropriate specialists, services and allied professionals.
If post-concussion care is provided within a network of providers rather than a clinic, it should:
- respond to individual patient needs
- consist of qualified and experienced interdisciplinary providers including a physician
- have a clear care pathway
- engage in comprehensive follow-up practices
- not unduly inconvenience patients (i.e. having to go to different settings/locales)
- use a model of collaborative, shared care so that each practitioner is aware of the treatment of the others and that there is regular communication regarding progress and treatment plan
A concussion clinic or network of providers should have clear internal and external communication mechanisms in order to improve coordination of care.
A concussion clinic or network of providers should track timely access to service, use suggested reporting and common data elements, and collect patient-level clinical data, demographic data and administrative data.