New patient information booklet results in better outcomes for people with traumatic brain injury

A new information booklet for people discharged from hospital after experiencing a traumatic brain injury (TBI) is giving consumers and whānau clearer information and advice about their injury, their care after discharge and their rehabilitation and recovery.

The booklet is the result of a quality improvement project at Te Whatu Ora Taranaki that was completed as part of a national collaborative focused on improving rehabilitation for patients with major trauma.

Taranaki Base Hospital admits approximately 30 people with a TBI each year. Data showed there were significant differences in the information and follow-up care that people received when they were discharged. This was because the correct discharge process was not well understood by staff, and information about what steps to take, such as making a referral to the Accident Compensation Corporation (ACC), was unclear. 

A staff survey showed that:

• the correct pathway for discharging people after TBI was not being followed consistently
• patients weren’t always receiving the correct referrals for follow-up in the community
• sixty-three percent of staff weren’t aware of the steps required to make a concussion referral to ACC
• there were inequities in the number of Māori being referred to concussion services
• the written materials for patient education at discharge were poor quality and out of date.

The project aimed to promote better outcomes for people diagnosed with moderate to severe TBI by improving the rates of staff correctly completing all parts of the discharge process and by giving clearer information to patients and their whānau for follow-up care when they return home.

The project team audited data about the people admitted to Taranaki Base Hospital following TBI over a two-year period (2019–21). It became clear that staff weren’t always completing the discharge section of the TBI pathway, which can only be considered complete when verbal or written discharge advice is given, an ACC concussion referral is completed and a follow-up appointment with the person’s general practitioner is requested. 

The team developed a new discharge information booklet for patients that gives information about their injury, describes some common symptoms they may experience and talks about rehabilitation and recovery. It also gives advice about pain management and returning to work and normal activities and has space for important contact information. 

The team also ran internal education sessions for medical, allied health and nursing staff focusing on the correct process for ACC referrals to concussion services, and the role and use of the discharge information booklet. The sessions highlighted the inequity in referral of Māori to rehabilitation services as an area of concern. Training for junior medical staff focused on good discharge processes and what referrals and follow-up are needed after a TBI.

Since the introduction of the information booklet, education sessions and ongoing training, the team has seen significant positive change. 

The rate of compliance with the discharge advice section of the TBI pathway increased from 17 percent in January 2020–March 2021 to a median of 36 percent in April–March 2022. Data also shows that the median compliance completing a referral for Māori increased from 0 percent to 30 percent for the same time period. Ongoing data collection will determine whether this increase is sustained.

The team has seen a marked increase in staff knowledge about discharge for people with TBI, and feedback from consumers has been positive, with many saying that they referred to the information in the discharge booklet after leaving the hospital.

Core staff continue to monitor concussion referrals, train new staff and audit whether education and training are effective. 

Data collected so far suggests that the improvements are being sustained, and the team hopes to apply the quality improvement techniques they learned during the project to improve further. 

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 Taranaki below.