Trauma System Support to Facilitate Recovery

Abstract

Summary:Trauma is a major public health issue. Orthopaedic trauma surgeons are skilled in the acute management of musculoskeletal injury; however, formal training and resources have not been devoted to optimizing recovery after trauma. Recovery entails addressing the biomedical aspects of injury, as well as the psychological and social factors. The purposes of this study were to describe existing programs and resources within trauma centers, developed to promote psychosocial recovery. Supporting research data will be referenced, and potential barriers to program implementation will be discussed. The American College of Surgeons has mandated screening and treatment for mental illness after trauma, which will raise the bar to highlight the importance of these social issues, likely enabling providers to develop new programs and other resources within their systems. Provider education will promote the informing of patients and families, with the intent of enhancing the efficiency and scope of recovery.

Optimizing recovery after trauma: overview of existing literature and practices

“…Resources to optimize aspects of rehabilitation and recovery, including mental and social health needs, are lacking or absent in most modern health systems. [98][99][100] Unfortunately, this results in protracted and often incomplete recovery. In addition to the physical elements of an acute injury, which may or may not return to the pre-injury baseline, the mental distress and the social and economic consequences are profound, often permanently altering the lives of injured people.…”

“…Not only are these the best ways to proceed from a holistic approach to care, but cost-effectiveness has been shown, in that complications, readmissions, and recidivism are mitigated. 19,20,26,30,66,71,[77][78][79][80][81]99 In the USA, insurance compensation for such services has also provided ample revenue generation. 101 Beyond screening and ad hoc provision of mental and social services, formal recovery programmes that encompass some of these needs and have the potential for a broader scope have been developed.…”

“…101 Beyond screening and ad hoc provision of mental and social services, formal recovery programmes that encompass some of these needs and have the potential for a broader scope have been developed. 14,23,24,99,[102][103][104][105][106][107][108] The subsequent paragraphs will briefly describe some of the existing programmes to date and will illustrate benefits to all constituents while denoting opportunities for future improvement. Table III shows some of the potential elements of recovery services.…”

“…However, professional societies are increasingly realizing the detrimental impact of not addressing these concerns. 18,99,100 A recently growing body of literature has shown that screening and treatment of aforementioned needs will have short- and longer-term positive effects. System processes to screen for substance abuse, chronic pain, mental illness (at a minimum anxiety, depression, and PTSD), and social circumstances should be implemented.…”

“…Not only are these the best ways to proceed from a holistic approach to care, but cost-effectiveness has been shown, in that complications, readmissions, and recidivism are mitigated. 19,20,26,30,66,71,77-81,99 In the USA, insurance compensation for such services has also provided ample revenue generation. 101…”