Changes to discharge summaries improves support for major trauma patients in Nelson Marlborough

Changes to the information patients are given when discharged from Nelson Hospital has had a positive impact on patient satisfaction and rehabilitation.

A project run by a local project team as part of a major trauma rehabilitation collaborative identified that patients who were being discharged from hospital following major trauma weren’t receiving the information they needed in order to access the right rehabilitation services.

The transition from hospital to the community was difficult for patients and their whānau to navigate because there could be multiple agencies involved in their rehabilitation (for example, ACC, community rehabilitation providers, district nurses and more). It was often unclear to patients whether they needed to arrange their own follow-up appointments, or if these had been made for them, and they weren’t always given clear information.

The project team held interviews with patients who had been discharged following major trauma to understand which areas of discharge planning could be improved. The concerns raised by patients included:

• not being able to remember their discharge instructions because the strong medication they needed to take affected their memory
• not understanding that in some cases they had to organise their own rehabilitation or liaise with ACC to make a return-to-work plan
• not having knowledge of the date and time of scheduled home physiotherapy visits
• not knowing the names, roles or responsibilities of the community rehabilitation staff involved in their care
• a lack of understanding about how long it would take for them to get back to normal.

This information helped the project team develop a survey for other major trauma patients. Coordination of care in the community, patients’ understanding of their rehabilitation plan and follow-up appointments once discharged were identified by the survey as the areas that needed most improvement.

The project aimed to provide what patients felt was the most valuable information on discharge, such as booked follow-up appointments and self-care. They also aimed to increase the rate of discharge summaries completed on the day of discharge for major trauma patients from 73 percent to 90 percent.

The project team developed a major trauma discharge checklist for the multidisciplinary team to complete, which became a prompt for clinical staff to make sure the appropriate referrals were made and the right information was passed on to patients (such as wound care advice and driving restrictions) before they went home. Information about rehabilitation plans or whether the patient needed to follow up their own appointments was included.

Education about the new process was targeted at house officers and registrars who complete most discharge summaries, and this focused on the importance of completing discharge paperwork on time so patients could return home well informed.

The project was a great success and, on completion, 100 percent of all major trauma patients discharged from Nelson Hospital were receiving their discharge summaries on the day of discharge.

Read the full case study from Te Whatu Ora Nelson Marlborough below.

In 2021, the trauma rehabilitation national collaborative brought together 11 teams of rehabilitation clinicians from across Aotearoa New Zealand to complete quality improvement projects that would improve outcomes for patients’ rehabilitation after major trauma. The collaborative is part of a broader programme of work by the National Trauma Network, Accident Compensation Corporation and Te Tāhū Hauora Health Quality & Safety Commission to establish a contemporary system of trauma care in Aotearoa New Zealand. Find out more about the programme here.