Improving patient experience and outcomes following serious injury

To explore injured patients' experiences of care to identify areas for improvement in routine service delivery from surgical teams in the transition from inpatient to community-based care.

Qualitative study drawing on 17 in-depth, semi-structured interviews, conducted from 1 October 2017 to 31 November 2017, with trauma patients (and patient-nominated key support people and health or social care professionals) registered by the Midland Trauma System Registry (New Zealand).

All patient respondents had been under the primary care of surgical sub-specialty teams at Waikato Hospital rather than the specialised trauma service that primarily cares for patients with major multi-system trauma. Patients perceived their pre-hospital and emergency care as high quality and highly valued the compassion of staff during their inpatient phase of care. Exceptions were the perception of communication gaps across the spectrum of care from admission to discharge and beyond, limited access to psychosocial services to manage ongoing psychological trauma and a lack of preparedness for discharge. Following discharge, respondents reported the high level of reliance on key support people, inadequate information provision about what to expect in relation to the journey through the health system after discharge, and a lack of coordination of post-discharge care.

This study highlights perceived issues in the patient care pathway in the transition from inpatient to community-based care, especially communication and discharge information provided by surgical clinical teams and Accident Compensation Corporation (ACC). Comprehensive inpatient care and clinical handover to primary care (rather than discharge planning processes) by dedicated clinical trauma services may provide more holistic models for surgical services to improve their influence on the transition of trauma patients into the community, assisted by organisation changes and support to enable effective service delivery. Specifically, trauma patients and their carers perceived the need for better screening and treatment for psychological trauma in the inpatient and outpatient setting; better information exchange prior to the transition from inpatient to primary care; more convenient and accessible follow-up services including a single point of contact for coordination of post-discharge care; and acknowledgement and practical support to relieve the significant and pervasive carer burden identified in this study. These findings provide the opportunity to implement focused system changes to provide more equitable and effective support in the transition to community care and beyond. The end result will be better experiences for patients and whānau, and improved health and vocational outcomes following serious injury.