Feasibility of a trauma quality-of-life follow-up clinic. J Trauma Acute Care Surg 2020 Jul;89(1):226-229
Date
03/17/2020Pubmed ID
32176166DOI
10.1097/TA.0000000000002672Scopus ID
2-s2.0-85088576680 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
BACKGROUND: Little effort has been made to address long-term quality of life, chronic pain (CP), posttraumatic stress disorder (PTSD), and functional disability in trauma survivors. This quality initiative was developed to determine feasibility of a coordinated, comprehensive, patient-centered follow-up clinic for those at risk for poor long-term outcomes.
METHODS: A convenience sample from 649 hospitalized trauma patients at a Midwestern level 1 trauma center between February 2018 and August 2018 was screened for risk of PTSD and CP. Thirty-six patients were randomized into a standard follow-up clinic (standard of care [SOC]) (2-week postdischarge surgical clinic) or a new trauma quality of life clinic (TQOL). The TQOL was developed to provide comprehensive care to patients at high risk for PTSD (Injured Trauma Survivor Score, ≥2) and/or CP (discharge pain score, ≥4). Trauma quality of life clinic included a nurse practitioner or surgeon (physician), psychologist, social worker, and physical therapist at 1-week post discharge. All providers saw the patient independently, developed a care plan collaboratively, and communicated the plan to the patient. The SOC involved a visit only with a nurse practitioner or surgeon (medical doctor). Measures of pain, PTSD, depression, quality of life, physical functioning, and life satisfaction were completed at time of the TQOL/SOC or over the phone.
RESULTS: There were no differences in demographics, readmissions, or emergency department visits after discharge between groups. However, no show rates were almost twice as high in SOC (40%) compared with TQOL (22%) and those in TQOL completed 23 additional psychology visits versus one psychology visit in SOC. This clinic structure is feasible for high-risk patients, and TQOL patients demonstrated improved engagement in their care.
CONCLUSIONS: A comprehensive multidisciplinary TQOL addressing issues affecting convalescence for trauma patients at high risk for developing PTSD and CP can improve follow-up rates to ensure patients are recovering successfully.
LEVEL OF EVIDENCE: Therapeutic, Level IV.
Author List
Trevino C, Geier T, Timmer-Murillo SC, Shawlin M, Milia DJ, Codner P, deRoon-Cassini TAuthors
Timothy J. Geier PhD Assistant Professor in the Surgery department at Medical College of WisconsinDavid J. Milia MD Professor in the Surgery department at Medical College of Wisconsin
Sydney Timmer-Murillo PhD Assistant Professor in the Surgery department at Medical College of Wisconsin
Colleen Trevino PhD APP Clinical Dir Inpatient 2 in the Surgery department at Medical College of Wisconsin
Terri A. deRoon Cassini PhD Center Director, Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAftercare
Chronic Pain
Convalescence
Feasibility Studies
Female
Humans
Injury Severity Score
Male
Pain Measurement
Prospective Studies
Quality of Life
Stress Disorders, Post-Traumatic
Trauma Centers
Wisconsin
Wounds and Injuries
