Abstract
Background: Traumatic injury is a public health problem of enormous magnitude; it can be measured by years of productive life lost, prolonged or permanent disability, or financial cost. The optimal care of patients with traumatic injuries requires a coordinated and integrated system of trauma care.1 Improvements in outcomes for patients can be achieved by providing patient-focused and planned trauma care.
Approach: The Inpatient Trauma Service (IPTS) was established in June 2023 with the aim of co-ordinating the care of the trauma patients upon presentation to hospital and aims to expedite their journey to recovery. The IPTS is a consultant-led multidisciplinary team in the MTC which integrates acute trauma teams with a dedicated trauma multidisciplinary rehabilitation team.
The IPTS identifies injuries, coordinates acute care, assesses rehabilitation needs and delivers acute rehabilitation, and provides timely onward referral to post-acute rehabilitation services. In conjunction with patients, the team created a patient “Trauma Recovery” booklet which is used for each patient to describe each individual’s injuries and supports them through their journey to recovery in a patient-centred approach.
Data was analysed from the first year since the establishment of the IPTS.
Outcome measures used include: Standards based on the UK National Clinical Audit for Specialist Rehabilitation following Major Injury (NCASRI) Patients who are thought to have complex needs for rehabilitation should be assessed within 10 days of referral and transferred to specialist rehabilitation within 6 weeks of being fit for transfer.
The rehabilitation complexity scale (RCS-e) was used to measure the complexity of rehabilitation throughout the patients stay in the major trauma centre.
Results:
100% of patients with complex rehabilitation needs were assessed within 10 days of referral.
There was a reduction in RCS-e from admission to discharge from the MTC.
No patients requiring post-acute complex specialist inpatient rehabilitation services were admitted within 6 weeks and many of them received this in an acute setting. Patients can wait 6-18 months for specialist services.
Patient’s have positively responded to the introduction of the patient Trauma Recovery booklet describing it as ‘empowering,’ ‘pivotal,’ ‘reassuring’.
Implications: The IPTS has a proactive approach to identification of rehabilitation needs following a trauma, early intervention reducing rehabilitation complexity, and ensures the patient is referred to appropriate services.
The enhancement of acute trauma rehabilitation has impacted patients by orchestrating seamless care within the major trauma centre. The establishment of the IPTS team has allowed for the objective measurement of rehabilitation needs of trauma patients which can better inform the future phases of Ireland’s trauma network strategy to achieve integrated trauma care after the patient leaves the major trauma centre.
There is a need for post-acute, regional and community rehabilitation, to enable patients to achieve their maximum functional potential and receive integrated trauma care throughout the continuum of their trauma recovery journey.