Patient-Reported Experience Across the Preoperative Ambulatory Trauma Pathway: A Prospective Cross-Sectional Study in...

Introduction Ambulatory trauma pathways manage a substantial proportion of operative orthopedic trauma, yet patient experience across these pathways is poorly characterized. This study aimed to describe patient-reported experience across two preoperative pathway domains, the ED attendance and the home-waiting interval, and to identify operational factors associated with poor experience. Methods This prospective survey included 65 consecutive adult ambulatory trauma patients at a UK district general hospital (October to December 2023). Patients rated their ED and home-waiting experience on a five-point Likert scale before planned surgery. Operational pathway metrics were captured prospectively via a digital handover platform and linked to experience scores. Low (≤3/5) and high (>3/5) experience groups were compared using the Mann-Whitney U test. Factors associated with low home-waiting experience were examined by logistic regression. All analyses were exploratory. Results Sixty-five patients were included (median age, 50 years; 60 (92%) self-presented; 50 (77%) were first assessed by an emergency nurse practitioner). Patients rating their ED experience as low (≤3/5; n = 22) had waited longer for first clinician review than those rating it as high (n = 43): median 91 vs. 31 minutes (p < 0.001) and had a longer total ED stay (5.4 vs. 4.0 hours, p = 0.027), whereas time to triage did not differ (p = 0.97). Patients reporting low home-waiting experience (27/65, 42%) had a longer ED-to-surgery interval (median 7 vs. 3 days, p = 0.018) and more operative cancellations (p < 0.001); 21 (32%) experienced at least one cancellation, with dissatisfaction rising from 27% among those never canceled to 75% among those canceled twice or more. On multivariable analysis, both a longer interval (adjusted OR, 3.31) and operative cancellation (adjusted OR, 4.91) were independently associated with low home-waiting experience. Forty-seven patients (72%) were uncertain about surgery timing, 13 (20%) received no red-flag advice, and only 17 (26%) had attempted to contact the trauma team during the home-waiting interval, with no dedicated contact route available; patients who had made contact reported a better home-waiting experience (p = 0.024). Conclusions Patient experience across the preoperative ambulatory trauma pathway was associated with time to first clinician review, total ED time, the ED-to-surgery interval, and operative cancellation, but not with triage speed or clinician grade. Uncertainty about surgery timing was the most prevalent problem. A structured preoperative communication package, including a dedicated point of contact, is a low-cost intervention that directly addresses the failures patients described.