Trauma patient discharge and care transition experiences: Identifying opportunities for quality improvement in trauma centres

Conn, Lesley Gotlib; Zwaiman, Ashley; DasGupta, Tracey; Hales, Brigette; Watamaniuk, Aaron; Nathens, Avery B.

doi:10.1016/j.injury.2017.09.028

Cited by 25 publications

(24 citation statements)

References 33 publications

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“…When treating trauma patients, each additional day of excessive hospital stay is associated with a 5% increase in risk of developing independent hospital-associated medical complications. 24 Furthermore, the estimated cost of each day of hospitalization ranges from an average of $645-$3500 depending on state and ownership of the hospital. 25 Our study found a decreased LOS for prisoners compared to non-prisoners.…”

Section: Discussionmentioning

confidence: 99%

Comparative Outcomes for Trauma Patients in Prison and the General Population

Christian

Grigorian

et al. 2022

The American Surgeon™

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Background Prisoners are a vulnerable population, and there are few contemporary studies that consider trauma patient outcomes within the prisoner population. Therefore, we sought to provide a descriptive analysis of prisoners involved in trauma and evaluate whether a healthcare disparity exists. We hypothesized that prisoners and non-prisoners have a similar risk of mortality and in-hospital complications after trauma. Methods The Trauma Quality Improvement Program (2015-2016) was queried for trauma patients based upon location inside or outside of prison at the time of injury. A multivariable logistic regression analysis was performed to compare these groups for risk of mortality—the primary outcome. Results From 593,818 trauma patients, 1115 were located in prison. Compared to non-prisoners, prisoner trauma patients had no significant difference in mortality (5.1 vs 6.0%, P = .204). However, after adjusting for covariates, prisoners had a shorter length of stay (LOS) (mean days, 6.3 vs 7.8, P < .001), shorter intensive care unit (ICU) LOS (mean days, 5.44 vs 5.89, P = .004), and fewer complications, including lower rates of drug/alcohol withdrawal (.4% vs 1.1%, P = .030), pneumonia (.5 vs 1.6%, P = .004), and urinary tract infections (.0 vs 1.1%, P < .001). Upon performing a multivariable logistic regression model, prisoner trauma patients had a similar associated risk of mortality compared to non-prisoners (OR 1.61, CI .52-4.94, P = .409). Discussion Our results suggest that prisoner trauma patients at least receive equivalent treatment in terms of mortality and may have better outcomes when considering some complications. Future prospective studies are needed to confirm these results and explore other factors, which impact prisoner patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Comparative Outcomes for Trauma Patients in Prison and the General Population

Christian

Grigorian

et al. 2022

The American Surgeon™

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“…To that end, it was not clear in the included studies the extent to which system-level challenges, unique to different health systems and organizational contexts, impacted the health care transition of the persons with dementia and their families. For example, participant reports of experiencing pressurized discharge practices may reflect misalignment between the organizational level goals and pressures outweighing the need to improve micro level care practices ( Conn et al, 2018 ). Future research can explore and develop models of transitional care that help to mitigate system-level deficiencies and improve the health care transitions of patients and caregivers.…”

Section: Discussionmentioning

confidence: 99%

Using meta-ethnography to understand the care transition experience of people with dementia and their caregivers

et al. 2021

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Older adults living with dementia are at risk for more complex health care transitions than individuals without this condition, non-impaired individuals. Poor quality care transitions have resulted in a growing body of qualitative empirical literature that to date has not been synthesized. We conducted a systematic literature review by applying a meta-ethnography approach to answer the following question: How do older adults with dementia and/or their caregivers experience and perceive healthcare transition: Screening resulted in a total of 18 studies that met inclusion criteria. Our analysis revealed the following three categories associated with the health care transition: (1) Feelings associated with the healthcare transition; (2) processes associated with the healthcare transition; and (3) evaluating the quality of care associated with the health care transition. Each category is represented by several themes that together illustrate an interconnected and layered experience. The health care transition, often triggered by caregivers reaching a “tipping point,” is manifested by a variety of feelings, while simultaneously caregivers report managing abrupt transition plans and maintaining vigilance over care being provided to their family member. Future practice and research opportunities should be more inclusive of persons with dementia and should establish ways of better supporting caregivers through needs assessments, addressing feelings of grief, ongoing communication with the care team, and integrating more personalized knowledge at points of transition.

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“…Patients who experience injury-related trauma often have complex care needs and frequently require extensive support from multiple care providers during their hospital stay and recovery 3. Many of these patients experience gaps in care while in the hospital and when they are transferred elsewhere, whether to their home, to a rehabilitation facility or to another hospital 4–6. Other issues involving this population that have been identified in the literature include disrupted communication and information flow between services7; a lack of support for parents during paediatric trauma cases8; patients not being completely informed about their treatment options4; and patients being excluded from the decision making around their own course of treatment, which often include several phases 4…”

Section: Introductionmentioning

confidence: 99%

“…Patients who experience injury-related trauma frequently require care from multiple types of healthcare providers,3 and patient navigation can facilitate coordination between those care providers 17 18. It can also reduce barriers for patients both while accessing multiple care providers across the care system, as well as the gaps in care that frequently occur during transitions by coordinating and integrating care and advocating to fill those gaps at a systems level 4–6…”

Section: Introductionmentioning

confidence: 99%

Hospital-based patient navigation programmes for patients who experience injury-related trauma and their caregivers: a scoping review protocol

et al. 2022

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IntroductionPatients who experience injury-related trauma tend to have complex care needs and often require support from many different care providers. Many patients experience gaps in care while in the hospital and during transitions in care. Providing access to integrated care can improve outcomes for these patients. Patient navigation is one approach to improving the integration of care and proactively supporting patients and their caregivers as they navigate the healthcare system. The objective of this scoping review is to map the literature on the characteristics and impact of hospital-based patient navigation programmes that support patients who experience injury-related trauma and their caregivers.Methods and analysisThis review will be conducted in accordance with Joanna Briggs Institute methodology for scoping reviews. The review will include primary research studies, unpublished studies and evaluation reports related to patient navigation programmes for injury-related trauma in hospital settings. The databases to be searched will include CINAHL (EBSCO), EMBASE (Elsevier), ProQuest Nursing & Allied Health, PsycINFO (EBSCO) and MEDLINE (Ovid). Two independent reviewers will screen articles for relevance against the inclusion criteria. Results will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews (PRISMA-ScR) flow diagram and follow the PRISMA-ScR checklist. The extracted data will be presented both tabularly and narratively.Ethics and disseminationEthics approval is not required, as the scoping review will synthesise information from publicly available material. To disseminate the findings of this review, the authors will submit the results for publication in a medical or health sciences journal, present at relevant conferences and use other knowledge translation strategies to reach diverse stakeholders (eg, host webinars, share infographics).

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Trauma patient discharge and care transition experiences: Identifying opportunities for quality improvement in trauma centres

Cited by 25 publications

References 33 publications

Comparative Outcomes for Trauma Patients in Prison and the General Population

Comparative Outcomes for Trauma Patients in Prison and the General Population

Using meta-ethnography to understand the care transition experience of people with dementia and their caregivers

Hospital-based patient navigation programmes for patients who experience injury-related trauma and their caregivers: a scoping review protocol

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