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Purpose: Trauma centres have been proven to provide better outcomes in developed countries for overall trauma, but there is limited literature on the systematic factors that describe any discrepancies in outcomes for trauma laparotomies in these centres. This study was conducted to examine and interrogate the effect of systematic factors on patients undergoing a trauma laparotomy in a developed country, intending to identify potential discrepancies in the outcome. Methods: This was a retrospective study of all laparotomies performed for trauma at a level 1 trauma centre in New Zealand. All adult patients who had undergone an index laparotomy for trauma between February 2012 and November 2020 were identified and laparotomies for both blunt and penetrating trauma were included. Repeat laparotomies and trauma laparotomies in children were excluded. The primary clinical outcomes reviewed included morbidity, length of hospital stay, and mortality. All statistical analysis was performed using R v.4.0.3. Results: During the 9-year study period, 204 trauma laparotomies were performed at Waikato hospital. The majority (83.3%) were performed during office hours (170/204), and the remaining 16.7% were performed after hours (34/204). And 61.3% were performed on a weekday (125/204), whilst 38.7% were performed on the weekend/public holiday (79/204). Most of the parameters in office hours and after hours groups had no statistically significant difference, except lactate (p = 0.026). Most of the variables in weekday and weekend groups had no statistically significant difference, except pH, lactate, length of stay, and gastrointestinal complications (p = 0.012, p

Background and Objectives: Now more than ever, there is an obvious need to reduce the overall burden of disease and risk of premature mortality that are associated with mental health and substance use disorders among young people. However, the current state of research and evidence-based clinical care for high-risk substance use among youth is fragmented and scarce. The objective of the study is to establish consensus for the prevention, treatment, and management of high-risk substance use and overdose among youth (10 to 24 years old). Materials and Methods: A modified Delphi technique was used based on the combination of scientific evidence and clinical experience of a group of 31 experts representing 10 countries. A semi-structured questionnaire with five domains (clinical risks, target populations, intervention goals, intervention strategies, and settings/expertise) was shared with the panelists. Based on their responses, statements were developed, which were subsequently revised and finalized through three iterations of feedback. Results: Among the five major domains, 60 statements reached consensus. Importantly, experts agreed that screening in primary care and other clinical settings is recommended for all youth, and that the objectives of treating youth with high-risk substance use are to reduce harm and mortality while promoting resilience and healthy development. For all substance use disorders, evidence-based interventions should be available and should be used according to the needs and preferences of the patient. Involuntary admission was the only topic that did not reach consensus, mainly due to its ethical implications and resulting lack of comparable evidence. Conclusions: High-risk substance use and overdoses among youth have become a major challenge. The system’s response has been insufficient and needs substantial change. Internationally devised consensus statements provide a first step in system improvement and reform.

Introduction: A continuing policy and practice challenge in New Zealand has been how to reduce fragmentation and achieve more integrated care – co-ordinated care that provides a smooth and continuous transition between services, as patients receive health, rehabilitation and vocational services. The aim of this research is to explore injured patients’ experiences of care to identify areas for improvement in service delivery. Methods: Qualitative study drawing on 17 in-depth, semi-structured interviews, conducted from 1 October 2017 to 31 November 2017, with trauma patients (and patient-nominated key support people and health or social care professionals) registered by the Midland Trauma System Registry (New Zealand). Results: Patients perceived their pre-hospital and emergency care as high quality and highly valued the kindness of staff, although expressed concerns regarding access to psychosocial services to manage ongoing psychological trauma, the high level of reliance on key support people, inadequate information provision about what to expect in relation to the journey through the health system and a lack of preparedness for discharge. Trauma patients also perceived the need for a single point of contact for coordination of post-discharge care. Discussion: Surviving a traumatic event resulting in serious injury is a time of chaos and confusion for patients and their key support people. Inadequate communication from interprofessional health and social care professionals about what to expect in relation to the patient journey through the health and social care systems adds to this predicament significantly. Key support people are the single largest factor in facilitating patients’ recovery from serious injury yet are left significantly unsupported. Conclusion: This study identified several possible areas for improvement to service delivery following serious injury; specifically: (1) the review of service provider communication and service delivery processes and practices in co-design with former patients and key support people, including information sharing and discharge planning checklists; (2) screening for psychological trauma and facilitation of early engagement with psychological and counselling services; and (3) the review of outpatient clinic appointment booking practices and the use of virtual clinics. Lessons learned: These findings provide the opportunity to implement system changes, co-designed in partnership with patients, key support people, service and compensation providers, to support improved health and vocational outcomes following serious injury. Although undertaken in the Midland region, opportunities for improvement may apply to other healthcare contexts. Limitations: Complete exclusion of AIS body region one (head/neck) limited the number of eligible participants. Service provider perspectives were not fully explored as only a single participant from this group was nominated, which reinforced patient perceptions regarding lack of coordination of post-discharge care. Suggestions for future research: The size of this study limited the ability to explore the potential opportunities for improvement identified in smaller patient subgroups, including perceptions regarding cultural responsiveness. A larger study would provide the opportunity to explore more thoroughly additional opportunities for improvement.