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.

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Three distinct models of care are distributed inconsistently across BC's Level I-III trauma hospitals. Greater use of admitting trauma service and short-stay trauma unit models may improve the sustainability and accreditation compliance of our trauma system.

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Introduction: Pain management is a cornerstone of emergency department (ED) practice, yet ongoing pain after ED discharge and return visits for inadequate analgesia are common. Over-the-counter (OTC) acetaminophen and nonsteroidal anti-inflammatory drugs are widely accepted first line agents for mild to moderate pain. Previous research has not investigated how patients actually consume such agents after discharge, and if they consume them synergistically and at sufficient doses for optimal analgesia. We sought to determine the proportion of patients in ongoing pain post-discharge that were utilizing analgesics as well as the type and dose of agent(s) used. Methods: Adults presenting to our ED with an acutely painful musculoskeletal complaint during research assistant hours were eligible for enrollment. After excluding non-English speakers as well as admitted, pregnant/breastfeeding, and chronic pain patients, consenting subjects completed in-person questionnaires during their ED stay and a follow-up telephone interview 2-3 days later. Results: 158 individuals were approached during the study period, of which 99 enrolled. 78 completed follow-up. At follow-up, 71 (91%) individuals experienced ongoing pain with a median score of 5 (interquartile range (IQR) 3-6) on an 11-point scale. 48 (67%) of patients still in pain consumed analgesics in the preceding 24 hours. The most commonly used agents were acetaminophen by 18 individuals (38% of analgesic users), ibuprofen by 16 (33%), and naproxen by 9 (19%). 29 respondents (60% of analgesic users) were using solely oral OTC analgesics. Only 15 (31% of analgesic users) used multiple agents concurrently, and 11 (23%) used prescription opioids. Acetaminophen was used at a median daily dose of 1500mg (IQR 1000-2000mg), much lower than that recommended for maximal analgesia (4000mg). Ibuprofen daily doses (1200mg, IQR 800-1300mg) were slightly lower than typical recommended doses (1600mg, 400mg every 6 hours). Conclusion: Only two-thirds of patients with ongoing pain at 2-3 days post-ED discharge were consuming analgesics, most commonly acetaminophen and ibuprofen. Of patients using analgesics, less than one-third used multiple agents. OTC medications are not used by most patients at doses for maximal analgesia. It may be possible to reduce pain burden and repeat-visits in discharged ED patients by optimizing the use of OTC analgesics.