“…Consistent with previous research, our findings suggest that people with serious injuries living in regional areas use fewer health services than their metropolitan counterparts [ 28 , 29 , 30 , 31 ]. Having to travel further to access healthcare for people in regional areas may limit accessibility [ 5 , 8 , 24 ]. Compounding the challenge of distance, transportation difficulties [ 6 , 8 , 29 , 32 ] and a limited availability of skilled providers [ 7 , 33 ] have been reported as barriers to accessing necessary services for people with orthopaedic injuries, TBI, and SCI, particularly for those in regional areas.…”
Section: Discussionmentioning
confidence: 99%
“…Urban and regional disparities in access to care exist, with people living in regional areas travelling further to access post-discharge healthcare after major trauma [ 5 ]. Both people with serious injury and health professionals have reported limited availability and difficulties accessing necessary care as barriers to health service delivery following injury, particularly for people living in regional areas [ 6 , 7 , 8 ].…”
Section: Introductionmentioning
confidence: 99%
“…Despite survivors of serious injury having long-term and complex healthcare needs, the level of specialised care provided beyond hospital discharge varies depending on the type of injury [ 4 , 5 , 9 ]. People with TBI and SCI are more likely to receive rehabilitation from specialised services due to the complexity of these injuries [ 10 ].…”
This study aimed to describe regional variations in service use and distance travelled to post-discharge health services in the first three years following hospital discharge for people with transport-related orthopaedic, brain, and spinal cord injuries. Using linked data from the Victorian State Trauma Registry (VSTR) and Transport Accident Commission (TAC), we identified 1597 people who had sustained transport-related orthopaedic, brain, or spinal cord injuries between 2006 and 2016 that met the study inclusion criteria. The adjusted odds of GP service use for regional participants were 76% higher than for metropolitan participants in the orthopaedic and traumatic brain injury (TBI) groups. People with spinal cord injury (SCI) living in regional areas had 72% lower adjusted odds of accessing mental health, 76% lower adjusted odds of accessing OT services, and 82% lower adjusted odds of accessing physical therapies compared with people living in major cities. People with a TBI living in regional areas on average travelled significantly further to access all post-discharge health services compared with people with TBI in major cities. For visits to medical services, the median trip distance for regional participants was 76.61 km (95%CI: 16.01–132.21) for orthopaedic injuries, 104.05 km (95% CI: 51.55–182.78) for TBI, and 68.70 km (95%CI: 8.34–139.84) for SCI. Disparities in service use and distance travelled to health services exist between metropolitan Melbourne and regional Victoria following serious injury.
“…Consistent with previous research, our findings suggest that people with serious injuries living in regional areas use fewer health services than their metropolitan counterparts [ 28 , 29 , 30 , 31 ]. Having to travel further to access healthcare for people in regional areas may limit accessibility [ 5 , 8 , 24 ]. Compounding the challenge of distance, transportation difficulties [ 6 , 8 , 29 , 32 ] and a limited availability of skilled providers [ 7 , 33 ] have been reported as barriers to accessing necessary services for people with orthopaedic injuries, TBI, and SCI, particularly for those in regional areas.…”
Section: Discussionmentioning
confidence: 99%
“…Urban and regional disparities in access to care exist, with people living in regional areas travelling further to access post-discharge healthcare after major trauma [ 5 ]. Both people with serious injury and health professionals have reported limited availability and difficulties accessing necessary care as barriers to health service delivery following injury, particularly for people living in regional areas [ 6 , 7 , 8 ].…”
Section: Introductionmentioning
confidence: 99%
“…Despite survivors of serious injury having long-term and complex healthcare needs, the level of specialised care provided beyond hospital discharge varies depending on the type of injury [ 4 , 5 , 9 ]. People with TBI and SCI are more likely to receive rehabilitation from specialised services due to the complexity of these injuries [ 10 ].…”
This study aimed to describe regional variations in service use and distance travelled to post-discharge health services in the first three years following hospital discharge for people with transport-related orthopaedic, brain, and spinal cord injuries. Using linked data from the Victorian State Trauma Registry (VSTR) and Transport Accident Commission (TAC), we identified 1597 people who had sustained transport-related orthopaedic, brain, or spinal cord injuries between 2006 and 2016 that met the study inclusion criteria. The adjusted odds of GP service use for regional participants were 76% higher than for metropolitan participants in the orthopaedic and traumatic brain injury (TBI) groups. People with spinal cord injury (SCI) living in regional areas had 72% lower adjusted odds of accessing mental health, 76% lower adjusted odds of accessing OT services, and 82% lower adjusted odds of accessing physical therapies compared with people living in major cities. People with a TBI living in regional areas on average travelled significantly further to access all post-discharge health services compared with people with TBI in major cities. For visits to medical services, the median trip distance for regional participants was 76.61 km (95%CI: 16.01–132.21) for orthopaedic injuries, 104.05 km (95% CI: 51.55–182.78) for TBI, and 68.70 km (95%CI: 8.34–139.84) for SCI. Disparities in service use and distance travelled to health services exist between metropolitan Melbourne and regional Victoria following serious injury.
“…In a study of patients who failed to attend follow-up appointments after discharge from the hospital, Aaland et al (2012) found that the most common barriers were a lack of awareness of the appointment and distance from the clinic or hospital (Aaland et al, 2012). In rural communities, other barriers to follow-up include lack of transportation to follow-up appointments, lack offerings close to home (Duchin et al, 2022;Keeves et al, 2022).…”
mentioning
confidence: 99%
“…(2012) found that the most common barriers were a lack of awareness of the appointment and distance from the clinic or hospital (Aaland et al., 2012). In rural communities, other barriers to follow-up include lack of transportation to follow-up appointments, lack of family or social support, and lack of therapy service offerings close to home (Duchin et al., 2022; Keeves et al., 2022).
KEY POINTS
Efficient patient-centered discharge planning is important for patients and nursing staff.Utilization of a patient-centered discharge planning form was associated with an increased frequency of discharge orders written before noon.The form was utilized differently by the trauma advanced practice provider and the discharge-focused nurse, indicating that it can be used for both discharge planning and as a final checklist for imminent discharge.
BACKGROUND:
Comprehensive and multidisciplinary discharge planning can improve trauma patient throughput, decrease length of hospitalization, increase family and patient support, and expedite hospital discharge.
OBJECTIVE:
This study aimed to assess the feasibility and acceptability of implementing a patient-centered discharge plan form for adult trauma patients.
METHODS:
A single-center pilot study was conducted with adult trauma patients on a neurosurgical medical-surgical floor at a Level II trauma center in the Western United States from January to February 2023. The study had three phases: observation, pilot intervention, and follow-up. The key pilot intervention was the development of a standardized patient-centered discharge plan form, pilot tested by a trauma advanced practice provider and an inpatient discharge nurse. The primary outcome was the frequency of discharge orders being written before noon on the day of discharge. Qualitative and quantitative outcomes are reported.
RESULTS:
The discharge form was used for eight patients during the pilot intervention phase; an advanced practice provider and an inpatient discharge nurse each completed the forms for four patients. Five of eight observed patients had discharge orders before noon; the incidence of orders before noon was slightly higher when the form was completed by the discharge nurse (three of four patients) than by the advanced practice provider (two of four patients).
CONCLUSIONS:
The pilot study found that the patient-centered discharge plan form was feasible and acceptable to help improve the discharge process for trauma patients. Additional work to further refine the form's content and administration is warranted.
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