Continuing Trauma Care After Discharge, the Experience of Outpatient Trauma Clinics in British Columbia

Abstract

The recovery process from traumatic injuries, and the potential for complications, extends beyond the time of hospital discharge. In 2014, the Fraser Health Trauma Network established outpatient clinics to provide follow-up care for trauma patients after discharge from hospital. The following research questions were asked: Which services were commonly performed by our trauma clinics and how satisfied were patients with the care they received at our clinics? A survey was distributed to patients after their clinic visit to assess overall satisfaction and areas for improvement. A retrospective medical record review was performed to illustrate and quantify the interventions provided during clinic visits. During the first 22 months of clinic operation, a total of 412 appointments were scheduled and the attendance rate was 88%. The provided services included obtaining additional imaging (41% of visits), providing wound and brace care (16%), and initiating referrals to specialists (12%). Seventy-seven patient satisfaction surveys were returned during the study period, 34 in 2014 and 43 in 2015. Seventy-four percent of respondents strongly agreed, and 21% agreed that they were satisfied with the care they received in the clinic. Ninety percent found their visit helpful, and only 10% reported having additional medical issues that were not addressed during the appointment. At trauma clinic follow-up, discharged patients have ongoing care requirements, including a need for further investigation, specialist referral, and wound or brace issues that are likely to benefit from specialist trauma care. Patients were satisfied with the care provided by a postdischarge trauma clinic.

Scoping review of the literature to ascertain how follow-up care is provided to major trauma patients post discharge from acute care

“…One study who reported on two follow-up clinics as part of the same health organisation, found a reduction in both the presentations (from 6.4% to 5.1%) and readmission rates (from 7.1% to 6.5%). 44 …”

“…In both studies the advanced qualifications were specific to the psychologists involved in the team. In relation to the nursing roles, studies described educational levels in terms of the position title or experience: nurses were described as experienced35 having additional qualifications such as a nurse practitioner38 43 44 or advanced practice nurse 37…”

“…For patients who required multiple follow-up encounters, these were largely in relation to ongoing emotional or psychological support or therapy 27–31 40 43. Four studies reported multiple appointments to manage ongoing care in relation to injuries36 39 44 50 although from these, two reported that the majority of patients (between 65% and 84%) only required single visits 36 44…”

“…35 The majority of patients were satisfied with the follow-up service provided with one study reporting 90% of patients surveyed found the follow-up appointment helpful. 44 For patients who used telehealth to access follow-up care, 100% stated they thought this delivery method made it easier to access care. 41…”

“…One study who reported on two follow-up clinics as part of the same health organisation, found a reduction in both the presentations (from 6.4% to 5.1%) and readmission rates (from 7.1% to 6.5%). 44 The economic impact of follow-up following traumatic injury has not been well described; only two studies included economic evaluations. O'Reilly et al 39 provided a crude economic assessment of delivering follow-up where a comparison was made between the phone telehealth clinic to traditional face-to-face clinic.…”