Citation

Livingston DH, La Bagnara S, Sieck D, Yonclas P, Castellano C, Cho C, Walling PA, Mosenthal AC. J. Trauma Acute Care Surg. 2020; ePub(ePub): ePub.

Affiliation

From the Division of Trauma and Surgical Critical Care, Rutgers-New Jersey Medical School.

Copyright

(Copyright © 2020, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002775

PMID

32345893

Abstract

BACKGROUND: Returning patients to pre-injury status is the goal of a trauma system. Trauma Centers (TC) provide inpatient care, but post-discharge treatment is fragmented with clinic follow up rates <30%. PTSD and depression are common but few patients ever obtain necessary behavioral health services. We postulated that a multi-disciplinary Center for Trauma Survivorship (CTS) providing comprehensive care would meet patient's needs, improve post-discharge compliance, deliver behavioral health, and decrease unplanned ED visits and readmissions.

METHODS: Focus groups of trauma survivors were conducted to identify issues following TC discharge. CTS eligible patients are: ages 18-80, ICU stay >2 days or have a New Injury Severity Score (NISS) ≥16. CTS visits scheduled by a dedicated navigator and included physical and behavioral health care. Patients were screened for PTSD and depression. Patients screening positive were referred for behavioral health services. Patients were provided 24/7 access to the CTS team. Outcomes include: compliance with appointments, mental health visits, unplanned ED visits and readmissions in the year following discharge from the TC.

RESULTS: Patients universally felt abandoned by the TC after discharge. Over 1 year, 107 patients had 386 CTS visits. Average time for each appointment was >1 hour. CTS "no show" rate was 17%. 86% screening (+) for PTSD/depression successfully received behavioral health services. Post-discharge ED and hospital admissions was most often for infections or unrelated conditions. ED utilization was significantly lower than a similarly injured group of patients one year prior to the inception of the CTS.

CONCLUSIONS: A CTS fills the vast gaps in care following trauma center discharge leading to improved compliance with appointments and delivery of physical and behavioral health services. CTS also appears to decrease ED visits in the year following discharge. To achieve optimal long-term recovery from injury, trauma care must continue long after patients leave the trauma center. EVIDENCE LEVEL: III - therapeutic.

Language: en