Early access to a case manager improves access to rehabilitation services in Te Tai Tokerau

Consumers are receiving the support they need after leaving hospital following major trauma, thanks to a quality improvement project at Te Whatu Ora Te Tai Tokerau. The project has improved consumer satisfaction after discharge, by assigning an ACC case manager to be involved in planning their rehabilitation needs before they leave hospital.

The trauma service at Whāngarei Hospital was seeing approximately one in five people present to the emergency department within 90 days of their initial trauma. Wanting to understand the reasons for this, the project team completed a consumer survey which showed differences in satisfaction with care after discharge.

Some consumers were getting excellent support, while others struggled to access the services they needed or didn’t know what support was available or what to ask so that they could access it.

Allocating an ACC case manager before discharge was done in other parts of the country, but has not been in place at Whāngarei Hospital, despite being the facility with the highest trauma case load in Te Tai Tokerau. It means that an ACC case manager can participate in discharge planning while the person is still in hospital, plan the support that is needed, and understand and mitigate any potential barriers to attending appointments.

The project aim was that all patients would have an ACC early cover referral form (ACC7422) lodged within one week of their injury. The team was keen to see how implementing the process consistently could help their patients and impact on presentation to the emergency department.

The team developed a resource for staff to explain the process, created an intranet page with relevant information, followed up with consumers two-to-four weeks after discharge to discuss their experience and developed a resource for consumers about how to access Rongoa Māori services.

Initially, it was only consistent when the key project team members were heavily involved, but its use is now embedded into practice. Social workers routinely identify people with major trauma and begin the ACC approval process.

They have seen an increase in the completion of an ACC7422, from a median of 0 percent to 67 percent, and consumer satisfaction scores have increased.

The project team plans to compare how many patients who present to the emergency department after discharge had an ACC7422 lodged while they were in hospital with those who didn’t, with the aim of making further changes to improve the process and identify any other quality improvement opportunities.

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 (ACC) and the Health Quality & Safety Commission (the Commission) to establish a contemporary system of trauma care in Aotearoa New Zealand.

Find out more about the programme on the Commission’s website and read the full case study from Te Whatu Ora Te Tai Tokerau below.