A new inpatient to outpatient pathway; Improving continuity and quality for major trauma patients in an NHS MSK setting

Purpose

We identified variable waiting times from inpatient to outpatient care for major trauma patients. Patients’ expressed frustration and overspending due to patients attending multiple appointments with different therapists for different elements of their poly trauma. Balogh 2012 also found 82% of major trauma injuries do not return to pre-injury function.

Approach

This quality improvement project followed a plan, do, study, act (PDSA) methodology. Firstly we created inclusion criteria for patient involvement, this was in line with Trauma Audit and Research Network (TARN). We posted questionnaires about service provisions to trauma centres in the UK and uploaded via iCSP for more responses. We visited centres of excellence in the UK and also completed a scoping literature review on best care for outpatient trauma rehabilitation. We implemented 2 collaborative roles where 2 physiotherapists worked half a week each in inpatient major trauma and MSK outpatients. We began bedside booking, which would be with the split rotation therapist to improve continuity of care. The effectiveness of this was evaluated by collecting the following outcome measures: PHQ9, GAD-7 and SF-36 at initial assessment, 6-month follow up and at discharge. As well as a patient satisfaction questionnaire and informal staff feedback. In the next phase we are implementing a major trauma class. This includes gym-based rehabilitation. It will be supported by the trauma clinical psychology team and the ‘After Trauma’ app to provide patients with information and support with all other aspects of coming to terms with major trauma.

Outcomes

Results: Our scoping review found little to no relevant literature. We had 16 responses from national questionnaire which revealed no standardisation of pathways or treatment prescription. From the preliminary data from 24 patients there was a significant improvement in all outcome measures: SF-36 by 42.2, GAD-7 by 2.25 and PHQ-9 by 3.5. This indicated a reduction in grading severity of depression from mild to minimal and a significant improvement in quality of life. Feedback from patient and staff was positive. Staff felt more supported by other teams including clinical psychology in a more multi-disciplinary fashion. All patients were booked from bedside and seen within a month.

Conclusion(s): Since its implementation the pathway has been a success for patients and therapists. There was a significant improvement in patients’ outcomes, experience and quality of life from preliminary data. The staff feel more supported and have access to more specialised professional learning in complex poly trauma. MDT links were strengthened via this project.

Cost and savings

No further data. 

Implications

We aim to continue to collect data and feedback. Since the implementation of major trauma centres in 2012 many more lives have been saved. However quality of life and return to work in the longer term should not be forgotten. To address this further research, funding and guidance in rehabilitation is needed.

Top three learning points

No further information 

Funding acknowledgements

No funding