The Hidden Effects of Trauma

Purpose

Since the introduction of the Major Trauma Network the NHS has saved an additional 1,600 patients with severe and live changing injuries Patients are exceeding their probability of survival scores, through the development of robust pre-hospitalisation pathways, early access to investigation and being treated in the right place by the right team. Patients who would have previously died from there injuries are now requiring complex rehabilitation not only of their physical injuries but of the non-physical morbidities as well. The overall aim of the project was to enhance the rehabilitation experience for patients following major trauma by improving the therapists’ ability to identify and manage the non-physical morbidities. Key objectives are: 1)To improve the therapists ability to identify and manage the non-physical complications of trauma 2)To improve the patients’ engagement and experience in rehabilitation 3)To identify the prevalence of non-physical morbidities and collate data to support a business case for psychological input at University Hospital of Southampton.

1.3 to 4.1
was the average number of management strategies implemented pre and post education

Approach

A multidisciplinary project involving Physiotherapists, Occupational therapists and Psychologists. A driver diagram was implemented to breakdown the overall improvement goal into its underpinning drivers and created change ideas; 1) To develop a communication tool to facilitate early identification of the non-physical morbidities and to promote open conservation 2) To improve the major trauma initial interview to include risk factors and identify concerns and anxieties 3) To develop a resource file for the therapists that includes treatment techniques, external resources, onward referral and outcome measures 4) To develop pathways for each non-physical morbidity, to manage risk and guide the therapists on the management of each non-physical morbidity including escalation to psychology / psychiatry 5) Clinical supervision with psychologists The change ideas were implemented using a PDSA cycle. NHS improvement tools 'brainstorming' and the 'sustainability model' were implemented to enhance project success. A patient experience of care survey evaluated patient experience and prevalence of the non-physical morbidities. The project was implemented over a 5 month period. Project population: 56 patients with an Injury Severity Score >15.

Outcomes

Results: The average number of non-physical morbidities identified increased from 1.2 to 2.1 per patient The average number of management strategies implemented increased from 1.3 to 4.1 per patient A 27% increase in patients rating their rehabilitation experience as ‘very good’ The point prevalence for each non-physical morbidity experienced following trauma were low mood 70%, anxiety 66%, anxiety re returning to their normal role 64%, anxiety regarding coping at home 62%, Post Traumatic Stress Disorder 34%, orientation issues 26% and body image issues 9%. Of the 54 patients discussed with the psychologists 26% of cases would have been appropriate for referral to inpatient psychology.

Conclusion(s): The project improved the therapists’ ability to identify and manage the non-physical morbidities and enhanced the patients’ rehabilitation experience. The project provides valuable evidence for a dedicated psychology service for major trauma patients, early in their rehabilitation pathway

Cost and savings

None.

Implications

This project aims to highlight the need for an integrated approach to rehabilitation of the physical and psychological effects of trauma to maximise rehabilitation potential.

Top three learning points

No further information. 

Funding acknowledgements

Unfunded