Every year in Aotearoa New Zealand, around 2,000 people are admitted to hospital with major trauma – defined as severe or multiple injuries that pose a threat to life.
In 2021, as part of a contract with the Accident Compensation Corporation (ACC) to support Te Hononga Whētuki ā-Motu | National Trauma Network, Te Tāhū Hauora Health Quality & Safety Commission brought together 11 teams of clinicians from across the country to establish a national trauma care system and improve rehabilitation outcomes.
As the tertiary major trauma centre for an area stretching to Hawke's Bay, across to Whanganui and south to Nelson Marlborough, Wellington Regional Hospital was well placed to host a project to improve major trauma patients’ inpatient experience.
Focusing on allied health therapy delivered to adult major trauma patients in an acute orthopaedic ward, a team including an orthopaedic physiotherapist, social worker, quality improvement advisors and two consumer representatives was formed to kickstart the project.
Step one was to capture the then-current state of major trauma care at Wellington Regional Hospital. Working with consumers, a survey was put together that asked patients about their experiences of:
- communication and information sharing
- respect and recognition of cultural and spiritual needs
- care experience
- patient-centred care
- allied health therapy input
- pain management
- discharge planning.
The survey responses revealed that allied health therapy input and patient-centred care were the key areas needing attention. Specifically, consumers highlighted:
- a lack of understanding about allied health staff roles
- concerns about the amount of therapy time provided
- that therapy was not being continued by non-allied health workers (nursing and health care assistants)
- a lack of therapy on offer at weekends.
Consumers also cited a disconnect in setting rehabilitation goals and a lack of whānau involvement in patient rehabilitation journeys.
Case studies collected by the team showed the significant impact on patients of short staffing in allied health services, gaps in staff skills and experience, a lack of knowledge on the roles and responsibilities of multi-disciplinary teams, and the overall complexity of caring for major trauma patients.
Interviews with staff highlighted their concerns about a lack of time and resources to provide necessary therapy to patients. As a result, the team:
- worked with consumers to co-design, produce and distribute a major trauma booklet for orthopaedic ward patients. It focused on helping patients navigate their inpatient stay by addressing issues raised by the patient experience survey, such as clarifying the various roles allied health services played in rehabilitation and recovery and what ACC does. Key contact numbers were also provided to patients being discharged home
- created an ‘allied health handover form’ to improve communication between therapists and assistants. The form also includes information about exercise and equipment and mobility plans. The form has received positive feedback from staff and has reportedly helped improve planning and teamwork while reducing duplication of care
- delivered education sessions for clinicians on successfully completing ACC705 referrals for ongoing rehabilitation services. Staff have reported that the forms being completed correctly has led to fewer requests from ACC for additional information and faster action referral times
- delivered education sessions to nursing staff about the roles of the allied health team and when and how to refer to these services. Results showed that the quality of referrals has improved, more referrals are being made and staff have more confidence navigating the referral system.
The team also noted some unanticipated benefits, such as strengthened relationships between the allied health services and the Wellington Regional Hospital trauma team. In particular, an allied health representative now sits on the hospital’s trauma committee and the Central Region Strategic Network.
Next steps include further improving the collection of and access to data around providing allied health services for major trauma patients so that inequities can be better identified.
Find out more about the programme and read the full case study by clicking the links below.