Australian Multidisciplinary Concussion Clinic: A New Model of Care.

Concussive injuries include a broad range of symptoms affecting physical, emotional, cognitive and sleep functions. Specialised clinics deliver targeted care guided by healthcare professionals. Traditionally, these clinics were centred around the medical specialist who referred patients to other disciplines as needed. However, contemporary clinics increasingly adopt a multidisciplinary approach, integrating various healthcare providers such as nurse practitioners (NP), clinical nurse consultants (CNC), clinical nurse specialists (CNS), neuropsychologists, physiotherapists, exercise physiologists and related professionals within the same service.

The Neuroscience Network at RNSH has established a strong legacy of community engagement, particularly through head injury education initiatives and collaborative guideline development with local schools. In recent years, concussion has emerged as a focal point of intensive clinical and public discourse. Defined medically as a type of mild traumatic brain injury (Bielanin, Metwally, Paruchuri & Sun, 2023), concussion management presents significant challenges. Without appropriate and standardised guidance, inconsistent approaches often lead to inappropriate treatment, mismanagement, extended school absences, worsening symptoms, psychological complications including anxiety and depression, and hospital readmissions. Research indicates that concussion remains an underdiagnosed and largely invisible condition across all fields (Fried, Balla, Catalogna, Kozer, Oren-Amit, Hedanny & Efrati 2022). The convergence of increasing concussion presentations to the emergency department (ED), coupled with heightened media interest in concussion, dementia and chronic traumatic encephalopathy (CTE), highlighted the critical need for a dedicated specialty clinic.

The aim of this endeavour was to establish a comprehensive integrated multidisciplinary Concussion Service at RNSH, a tertiary referral centre. This service will deliver in-real-time collaborative assessments where multiple specialists, in a multidisciplinary team (MDT), evaluate patients concurrently in a single clinical setting (i.e. in the same consulting room). The service will also deliver essential education, facilitate safe and structured return to activity protocols for study, work, and sport, and ensure coordinated patient management across all domains of recovery.

A comprehensive community consultation process was initiated with local school and sporting groups to gather data through questionnaires, facilitated discussions and focus groups at several hospital forums. Following educational outreach sessions at local schools, a dedicated focus group was established within the School Nurses Association, to address their specific concussion-related concerns.

Hospital stakeholders representing diverse clinical and administrative departments were convened to assess comprehensive service needs. The multidisciplinary coalition included representatives from paediatrics, neurology, neuropsychology, emergency, the Divisions of Surgery, Medicine and Women’s & Children’s Health, Health Promotions Services, the Youth Advisory Group, GP Network, and First Nation peoples. This extensive collaboration revealed significant knowledge gaps regarding concussion identification, diagnosis, treatment protocols and ongoing management.

To establish a service rooted in evidence-based practice, specialised guidance was sought from the Children’s Hospital Institute of Sports Medicine (CHISM) at Westmead Children’s Hospital. Given the absence of comparable multidisciplinary concussion services within Australia, international benchmarking became essential. This rigorous process involved consultation with leading institutions worldwide, including the Barrow Neurological Institute (Arizona, USA), NYU Langone Hospital (New York, USA) and the Ontario Concussion Group (Ontario, Canada).

The collective insights from these consultations, combined with data from Northern Sydney Local Health District (NSLHD) Emergency Departments (EDs), and local general practitioners (GPs), informed a formal submission to the NSLHD Executive. This proposal recommended two key implementation strategies:

• Concussion Educational Video – Developed as the initial intervention, this resource has subsequently been adopted as an educational tool by the NSW Education Department, New Zealand schools and many sporting clubs across Australia and New Zealand. The link can be found at https://vimeo.com/674645370

• Integrated MDT Concussion Clinic – Established with a core clinical team comprising a paediatric sport and exercise physician, adult neurologist, neuropsychologist and clinical nurse consultant. This service employs a truly collaborative approach where all specialists simultaneously participate in patient assessments, enabling comprehensive evaluation and coordinated care planning. Additionally, the clinic pioneered seeing patients as early as 10 days post-concussion, rather than traditional clinics that often accept referrals at the time patients are diagnosed with persisting symptoms (i.e. beyond four-weeks).

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Traditional models typically operate on a 1:1 provider-patient basis with specialist seeing patients individually, even when working within a multidisciplinary team. The RNSH Concussion Clinic, as far as we are aware, represents a groundbreaking innovation in Australian Healthcare, offering specialised concussion management as early as 10 days post-concussion, highlighting the importance of early intervention, with an integrated MDT framework where clinicians collaborate simultaneously during patient consultations.

Traditional approaches often focus on specialised knowledge within a single discipline, while the Concussion MDT offers insight from a neurologist (or paediatric neurologist), neuropsychologist and clinical nurse consultant, all at the same time. The team operates on foundational principles of effective communication, seamless coordination, mutual respect, and professional trust. The clinical nurse consultant serves as the practice leader, orchestrating and facilitating team functions through essential skills in communication, problem solving, collaboration and adaptability.

Recent research by Dawe, Cronshaw & Frerk (2024) identifies critical collaborative competencies including active listening among team members, transparent communication protocols, systematic knowledge sharing, and unified professional goal alignment. Within this framework, the patient remains the central focus of all clinical decisions. Recognising that each patient presents with unique requirements, attentive listening becomes essential to developing personalised care pathways that optimise outcomes.

Jangathan & Sullivan (2020) recommended individualised MDTs for improved patient management. The RNSH Concussion MDT currently delivers services through a structured weekly face-to-face clinic, with morning sessions dedicated to paediatric cases and the afternoon for adults. The appointment schedule allocate 60 minutes for new patients and 30 minutes for follow-up reviews. Most patients require two clinical visits, though individual cases may necessitate one, three, or occasionally four appointments based on clinical progress. The recommended interval between the initial assessment and follow-up visits is approximately 4 weeks. Notably, the service currently operates without wait times for new referrals. The clinical nurse consultant manages the triage and booking process and serves as the primary liaison between patients, their families and referring GPs.

The RNSH Concussion Clinic –

• Early Intervention and Integrated Multi-disciplinary Assessment Model: The clinic sees patients as soon as 10 days post-concussion for early intervention and employs a pioneering 1:3 patient-to-provider ratio, where each multidisciplinary team member simultaneously evaluates the patient in a collaborative setting. This approach yields more comprehensive clinical insights, facilitates immediate clarification of complex issues, and enables real-time consensus building. Patients receive personalised resource materials, detailed explanations, and structured action plans directly during their consultation, enhancing both understanding and adherence.

• Knowledge Translation and Community Integration: The clinic actively disseminates expertise through structured collaboration with healthcare networks, general practitioners, educational institutions, and community sporting organisations. This outreach includes detailed clinical summaries and strategic deployment of educational resources, creating a bidirectional knowledge exchange that strengthens community-based concussion management.

• Systems-Level Impact and Policy Development: The clinic has established a foundation for broader discussions at district, state, and national levels regarding standardisation of post-concussion care protocols and public awareness initiatives. This advocacy role positions the clinic as a catalyst for systemic improvement in concussion management across various healthcare contexts.

• Innovative Educational Resource Development: The clinic produced a concise five-minute educational video specifically designed for optimal engagement and retention. This resource employs strategic use of colour, animation, and authentic scenarios to effectively communicate critical concussion information within attention span limitations. The resource’s exceptional quality and utility are evidenced by its widespread adoption across New South Wales, broader Australia, and New Zealand educational systems. Notable institutional integration includes incorporation into NSW Education Department teacher training curriculum, New Zealand’s Public Health Unit programming, and documented implementation by numerous individual schools (see Appendix 1).

Concussion represents an invisible injury with far-reaching consequences. Optimal recovery and successful reintegration to educational, occupational, and recreational activities requires specialised management by a dedicated multidisciplinary team with concussion-specific expertise. Multidisciplinary practice accommodates the need for a comprehensive approach to concussion management. The innovative early intervention (10 days post-injury) and collaborative assessment model—where all specialists simultaneously evaluate and interact with the patient—has demonstrated significant benefits in both clinical outcomes and resource utilisation efficiency. This approach enables comprehensive, coordinated care planning that addresses the complex, multidimensional nature of concussion recovery within a single clinical encounter.