Improving patient experience and outcomes following serious injury

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.