Feasibility of a trauma quality-of-life follow-up clinic

Abstract

BACKGROUND Little effort has been made to address long-term quality of life, chronic pain (CP), posttraumatic stress disorder (PTSD), and functional disability in trauma survivors. This quality initiative was developed to determine feasibility of a coordinated, comprehensive, patient-centered follow-up clinic for those at risk for poor long-term outcomes. METHODS A convenience sample from 649 hospitalized trauma patients at a Midwestern level 1 trauma center between February 2018 and August 2018 was screened for risk of PTSD and CP. Thirty-six patients were randomized into a standard follow-up clinic (standard of care [SOC]) (2-week postdischarge surgical clinic) or a new trauma quality of life clinic (TQOL). The TQOL was developed to provide comprehensive care to patients at high risk for PTSD (Injured Trauma Survivor Score, ≥2) and/or CP (discharge pain score, ≥4). Trauma quality of life clinic included a nurse practitioner or surgeon (physician), psychologist, social worker, and physical therapist at 1-week post discharge. All providers saw the patient independently, developed a care plan collaboratively, and communicated the plan to the patient. The SOC involved a visit only with a nurse practitioner or surgeon (medical doctor). Measures of pain, PTSD, depression, quality of life, physical functioning, and life satisfaction were completed at time of the TQOL/SOC or over the phone. RESULTS There were no differences in demographics, readmissions, or emergency department visits after discharge between groups. However, no show rates were almost twice as high in SOC (40%) compared with TQOL (22%) and those in TQOL completed 23 additional psychology visits versus one psychology visit in SOC. This clinic structure is feasible for high-risk patients, and TQOL patients demonstrated improved engagement in their care. CONCLUSIONS A comprehensive multidisciplinary TQOL addressing issues affecting convalescence for trauma patients at high risk for developing PTSD and CP can improve follow-up rates to ensure patients are recovering successfully. LEVEL OF EVIDENCE Therapeutic, Level IV.

Center for Trauma Survivorship Improves Post-Discharge Follow-Up and Retention

“…While this may limit its external validity, the authors believe that the concept is both valid and necessary. Comparable programs in other level I trauma centers have had similar results 7,11 . This study also occurred during the height of the COVID-19 pandemic with the disruption of health care delivery.…”

“…This program significantly improved scheduling and complying with follow-up appointments 11 . Another program designed to target trauma survivors at high risk for posttraumatic stress disorder or chronic pain also demonstrated increased follow-up 7 . Improving follow-up rates can improve patient care.…”

“…11 Another program designed to target trauma survivors at high risk for posttraumatic stress disorder or chronic pain also demonstrated increased follow-up. 7 Improving follow-up rates can improve patient care. This should be a goal for all trauma centers, and similar programs should become standard practice.…”

“…These barriers to implementing postdischarge recovery programs in trauma patients are reported to include a difficulty with scheduling and making appointments, lack of time and money to go to appointments, transportation, and administrative support. 7 A paucity of research exists around these factors, and increasing patient retention within a health system has not been well evaluated in trauma patients. The Center for Trauma Survivorship (CTS) was created to improve postdischarge care of severely injured trauma patients.…”

“…Systemic barriers exist in health care delivery that limit postdischarge access and make navigating after discharge care problematic. These barriers to implementing postdischarge recovery programs in trauma patients are reported to include a difficulty with scheduling and making appointments, lack of time and money to go to appointments, transportation, and administrative support 7 . A paucity of research exists around these factors, and increasing patient retention within a health system has not been well evaluated in trauma patients.…”