Implementation of a Neurotrauma Hotline for post‐hospital continuity of care

Abstract

Background There are 4.8 million emergency department (ED) visits for traumatic brain injury (TBI) annually in the United States. Many of these patients do not receive educational information or follow‐up care. Aims of the Study Our institution implemented a Neurotrauma Hotline for TBI patients. This study describes our implementation and utilization of a Neurotrauma Hotline at a Level I trauma center. Methods Callers and outcomes of calls to the hotline over a 12‐month period were analyzed. Correlation analysis was done to assess relationship between hotline calls and TBI clinic volumes. Results There were 1205 calls to the hotline. Calls were most commonly from internal providers or patients, with 338 repeat callers. The call reason was frequently an appointment (36.8%) or advice (32.1%). There were 334 TBI clinic visits, and however, there was no statistically significant correlation between number of hotline calls and number of clinic visits (r = .417; P = .177). Conclusions There was widespread utilization of our hotline. Other institutions wishing to adopt similar practices can expect that the majority of calls will be for appointment scheduling or clinical advice. Further work is needed to determine whether implementation of a Neurotrauma Hotline improves resource utilization and patient outcomes.

Remote Follow-Up Technologies in Traumatic Brain Injury: A Scoping Review

“…Of the 40 articles retrieved, the plurality ( n = 15) were reported or deemed to be descriptive in design, 19 , 41–54 and included small, non-randomized pilot studies and secondary analyses of data, or in two studies, were conducted in or described the retrospective analysis of a quality improvement initiative format. 52 , 53 Citations with an observational design formed the second most common type ( n = 10), 10 , 55–63 encompassing prospective 55 , 56 , 58 and retrospective 10 cohort studies and cross-sectional studies. 57 , 60 , 61 Research of experimental (n = 9) 64–72 and quasi-experimental ( n = 6) 73–78 design was similar in frequency.…”

“…With respect to TBI severity, FUTs were most frequently implemented in cohorts of patients with TBI of undefined severity ( n = 14) 10 , 44 , 45 , 49 , 52 , 53 , 55 , 58 , 62 , 65 , 67 , 70 , 71 , 77 —in some of these cases, patient cohorts were pooled with other diagnoses (trauma, spinal cord injury, stroke, orthopedic, acquired brain injury, among other neurological conditions). Where TBI severity was defined, seven studies ( n = 7) explored the implementation of FUTs in all-severity TBI patient cohorts.…”

“…Telephone-based follow-up technology ( Table 1 ) was used in 21 studies (52.5%). 10 , 19 , 41 , 42 , 44–50 , 52 , 53 , 55 , 57 , 60 , 64 , 68 , 69 , 74 , 76 Telephones were primarily used as a synchronous means of two-way communication to conduct structured interviews with patients and their proxies. Although almost all studies, where defined, used clinical or research staff to conduct follow-up, one used an external call center that had integrated its systems with the hospital's electronic medical records 44 to complete the follow-up interview.…”

“… 66 Nursing personnel 41 , 52 , 69 formed the next largest pool of facilitators, and included specialist psychiatric nurses, 64 rehab-based nurse practitioners, 47 or neurosurgical nurse personnel experienced in TBI and/or neurotrauma outcome measure administration. 48 , 53 , 80 Undefined clinical staff, 43 speech-language pathologists, 70 , 71 physicians, 52 general therapists, 65 occupational therapists, 68 and care team members 67 were described as facilitators in a smaller subset of studies. In three studies, facilitators were primarily external non-clinical staff without familiarity of TBI, such as data clerks, 10 call center personnel, 44 or interviewers otherwise undefined.…”

“…Nine studies (22.5%) did not formally define the time-point at which remote assessment was attempted. 43 , 44 , 53 , 55 , 56 , 61 , 62 , 67 , 77…”