Trauma Navigation - Putting the Broken Pieces Back Together is No Accident

Abstract

Session H presented Friday, September 28, 2:30-3:30 pm Purpose: Care coordination begins the moment a patient is admitted and is an ongoing process. Transition management occurs every time a patient has a change in the level of services or location of healthcare providers as they move within the healthcare system. Whether transferring from the Emergency Department to a medical unit or to radiology and procedural areas and then beyond the facility and into the community, optimal patient outcomes are largely dependent upon the expertise of the nurse’s ability to coordinate their care and manage those transition. Poor coordination and transitions of care has been linked to adverse effects, low satisfaction with care, long hospital length of stay, and high readmission rate. Care coordination and transition management is especially important for the traumatically injured patient because these patients typically have numerous multi-system injuries requiring intervention from various specialties. Design: Staff development project developed by myself and the trauma services department. Setting: State Designated Level II Trauma Center. Participants/Subjects: The trauma committee and staff members participated in this project to include ED physicians, trauma surgeons, ED nurses, social services, and discharge planners. Methods: Clinical Navigator for Trauma Services employed and clinical rounding initiated: 1. Facilitates the opportunity for the trauma services line to monitor the care being provided to the patients in the trauma program and be able to deliver immediate response at the time of care. 2. Allows for meaningful connection to be made with patient and family members for teach-back education, assistance with identifying needed resources or care in the home, and opportunities for injury prevention. 3. Assists in streamlining the care coordination and transitions of complex trauma patients to improve multiple outcomes and decrease complications. 4. Provides the ability to have continuity of care for traumatically injured patients and their family members. Results/Outcomes: Pre-implantation of the clinical navigator for trauma services was from October 2014-Sept 2015 and post-implementation was from October 2015-June 2017: 1. Decrease in total amount of critiques and complications reported in the trauma registry from 17.84% to 9.43% of patients, 2. Decrease in length of stay in the critical care units for trauma activated patients from 2.87 average days to 2.26 average days, 3. Decrease in length of stay in the medical or surgical units for trauma activated patients from 4.8 average days to 3.6 average days, 4. Decrease in trauma patients readmitted to the hospital within 72 hours of discharge from 3.46% to 1.33% of patients, 5. Decrease in trauma patients readmitted to the hospital within 30 days of discharge from 6.3% to 4.99% of patients. Implications: A clinical navigator for trauma services should be employed by all trauma centers to ensure successful transitions and quality of care for the traumatically injured patient.