Major trauma patients in MidCentral receive quicker and more coordinated care thanks to new processes

Patients admitted to Palmerston North Hospital following major trauma are receiving support sooner and have greater involvement in the decision-making around their care.

This is thanks to a project at Te Pae Hauora o Ruahine o Tararua MidCentral that has improved care processes within their medical, nursing and allied health teams.

Diagnosing the problem

Until now, the quality and consistency of acute rehabilitation services for people admitted to Palmerston North Hospital following major trauma has varied widely.

The project team reviewed 59 admissions over six months in 2020 to assess the number of days it took patients to access services such as physiotherapy, occupational therapy, social work and acute pain input after major trauma. They learned that some patients were discharged from the acute ward setting without access to the right follow-up, and opportunities to start essential rehabilitation were missed. This could affect their outcomes and potentially lead to longer stays and more readmissions.

The data from 2020 showed that 20 percent of people did not attend outpatient appointments after their trauma. Sixty percent of those who did not attend were Māori or Pacific peoples. Eight percent of patients with trauma re-presented to hospital within 30 days of discharge.

Well on the way to 100 percent

The project team designed a major trauma pathway and implemented daily follow-up by a nurse specialist. This meant that people admitted with major trauma were identified early and referrals to allied health were made promptly. Patients and whānau had greater involvement in decision-making about their care and post-discharge follow-up, and they were connected to the relevant community supports.

The project aim was all adult major trauma inpatients to have appropriate multidisciplinary assessments completed before they were discharged from the inpatient ward, and this is well on the way to being achieved.

In the three months following the introduction of the major trauma pathway, 100 percent of inpatients had all required referrals made and responded to within one working day of admission.

The project has improved care processes within the medical, nursing and allied health teams. The teams now use an electronic whiteboard to track who is waiting for allied health follow-up, and nurse specialists conduct daily follow-ups of trauma patients. This has increased the knowledge and skills of ward staff in how to care for people after traumatic brain injury. Follow-up phone calls after discharge have smoothed patient transitions into the community.

All Māori and Pacific trauma patients are followed up, regardless of the severity of their injury. Nurse specialists identify specific supports the patient might need, such as assistance with transport or picking up their prescriptions, before they are discharged from hospital.

Equity improvements

Māori and Pacific peoples represented 60 percent of those who did not attend appointments, according to the baseline data. After the pathway was implemented, the overall number of people who didn’t attend outpatient appointments decreased substantially, from 20 percent in 2020 to five percent in 2022. This decrease occurred across all ethnicities equally. It is likely that the decrease is due to improved communication during the follow-up phone calls after discharge and the support offered to help patients attend their appointments.

The team’s efforts to improve the equity gap for Māori and Pacific peoples have improved access to services and seen ongoing patient and whānau participation in services.

The trauma rehabilitation national collaborative

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 in rehabilitation after major trauma. The rehabilitation collaborative formed 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 Pae Hauora o Ruahine o Tararua Midcentral below.