How is care provided for patients with paediatric trauma and their families in Australia? A mixed‐method study

Abstract

Aim: This study describes clinical staff opinions on the availability and suitability of resources to provide trauma care to children and their families and any perceived strengths, gaps and potential interventions to strengthen care. Methods: A mixed-method study was conducted in five Australian paediatric trauma centres. The trauma coordinator at each site participated in a structured interview to determine models of care and trauma activity at their site. This informed the development of an electronic survey, which sought staff opinion on child and family access to services and perceived gaps in care. Results: Five trauma coordinators were interviewed, and 214 clinicians (medical, nursing, allied health) from New South Wales, Victoria, South Australia and Queensland completed the survey. Each site had a trauma director and coordinator, and there was variance in resource availability. Almost all survey participants (92.5%) considered their hospital met the physical needs of injured children, 68.2% thought that the psychosocial needs of children were met and 82.1% thought that the needs of families were met. The least accessible services reported were clinical psychology/family counselling, mental health and behaviour management services. No routine follow-up support services post-discharge for the child or their families were identified. Conclusion: Staff providing care for injured children report that physical needs are better met than psychosocial needs. There is variability in resource levels across paediatric trauma centres. A coordinated model of care that provides psychosocial care both during hospitalisation and post-discharge could reduce this gap in care for injured children and their families.

Parent perspectives and psychosocial needs 2 years following child critical injury: A qualitative inquiry

“…Parents who required emotional support for themselves at any stage of the two years post their child's injury, had to independently seek it. These findings confirm those of an Australia wide survey of health professionals who reported physical needs are better met than psychosocial needs and that there are no routine follow-up support services post-discharge for injured children or their families [26] . Given the evidence that some parents and children continue to experience psychological distress two years following child injury, it is recommended that health professionals provide parents with anticipatory guidance and information on how to access psychological support for them and their child, at the child's discharge from hospital.…”

Resilient, recovering, distressed: A longitudinal qualitative study of parent psychosocial trajectories following child critical injury

“…Access to social and psychological support are key resilience resources [ 6 ]. The lack of follow-up psychological support in this study is reflective of findings from a 2016 Australia-wide study [ 37 ] that identified access to, and coordination of, services for injured children and their families was poor. This could be addressed by introducing a dedicated trauma support role to facilitate an integrated care approach to patients with complex needs across the care continuum.…”

“…This could be addressed by introducing a dedicated trauma support role to facilitate an integrated care approach to patients with complex needs across the care continuum. This role would collaborate with other health care professionals to assure timely coordination and communication of care across the state to provide safe, consistent, high quality care [ 37 ]. The role would serve as a consistent point of contact for complex cases providing additional support to the family from admission up to two years post discharge, and better support for parents who often have to act as a 'shadow healthcare system' [ 38 ] for their children following injury.…”

Hospital readmissions in paediatric trauma patients: A 10‐year Australian review

“…As most patients re‐presented to hospital and were readmitted within 1 week of discharge, they may have been discharged with limited or untimely follow‐up. A 2016 study found that no routine follow‐up support services post‐discharge for injured children or their families exist in Australia, and there is variability in resource levels across paediatric trauma centres . Post‐discharge services, including telephone calls, home visits, follow‐up appointments and discharge planning, may have some benefit in reducing some readmissions or in ensuring appropriate and timely readmission to hospital …”

“…Trauma co‐ordination roles in the adult trauma population have been shown to improve both patient and health service outcomes . Within paediatrics, the introduction of a care co‐ordination role for at least 2 years post‐discharge is likely to provide the benefits of continuity, monitoring and re‐screening of physical and psychosocial care for both the child and family and potentially reduce unnecessary readmissions …”