Trauma Case management
Kate Curtis
Outline
Trauma Case Management
Kate Curtis
What is it? Do you need it? Does it work?
Monitoring and Improving Trauma Care
• Identify problems
• Can they be fixed?
• What has been done elsewhere?
• Best option
• Measure the impact
Trauma Case Management
• Nursing
• Coordination
• Collaboration
• Advocacy
• Staff/Pt Satisfaction
• Financial benefits
Focus Groups
“The patient is not looked at as a whole by individual teams”
“It is unclear exactly which team should be calling the shots. I spend a lot of time on the phone trying to find out exactly what should be happening”
“Multiple teams increase workload, increase hassle and pain isn’t managed properly”
“One team will say that it’s not their problem, so you call the other team and they pass the buck…the patient picks up on this and is as frustrated as we are”
Survey Results
• 99% agreed communication is essential
• 21% agreed that communication is good between trauma patient carers
• 70% poor communication delays discharge
• 76% agree that trauma care would improve with one person overseeing care
Summary of problems
Can you improve trauma at your hospital?
Commonwealth International Health policy survey - NZ
• 48% dissatisfied with health system (Aus 35%)
• 24% Received conflicting information
• Care coordination problems
• 73% rated their doctor “excellent”
3. Investigate….
Who has done what?
Investigation
Literature
nurse case management
trauma clinical paths
nurse practitioners
trauma nurse coordinators
Investigation
• The internet
www.trauma.org
• Society of trauma nurses
www.traumanursesoc.org
• US trauma centres
• Trauma Coordinator Course
The best option
So prove it
Study Objectives
• A study to evaluate the effect of TCM on
• Allied Health Staff use
• In hospital complications
• Length of stay
– ED
– ICU
– HDU
– overall
• Staff Satisfaction
Methodology
• Pilot Study
• Criteria
• Resources
• Databases
– Trauma registry
– Casemix
• Analysis
– Study and control groups were matched
• 14months March to May 1999/2000 and 2002/3
– SPSS and access
Who are the case managers?
• High level experience and ability in……..
– Coordination
– Negotiation
– Communication
– Time management
– Holistic thinking
What does that mean???
• Admission checklist
• Know what is going on with each patient each day
• Example
Results
• 777 patients in control
• 754 patients in TCM group
Patients receiving Allied Health Intervention (%)
Time to Allied Health Intervention
Number of Complications
Unplanned ICU and Operations
Complication Implications
Increased
• Morbidity/mortality
• Length of stay
• Re-presentation to the ED
• Expense
• Return to work
• Medicolegal
Total Hospital LOS by age group
Ward LOS
Total Pathology and Radiology Tests
Results – Staff satisfaction
Percentage of staff stating improvement in;
• Communication 85%
• Radiology review 86%
• Documentation 86%
• Discharge efficiency 72%
• Team referral 89%
• Pain Management 66%
• Aware of plan 86%
Why does TCM work??
• More efficient use of Allied Health
• Global, holistic approach - checklist
• Resource awareness and surgical team time poor
• Increased levels of communication and education
In summary….. TCM…….
• Increases allied health referral rates
• Decreases time to being seen by AH
• Decreases patient morbidity
• Decreases pathology test rates
• Decreases LOS overall
• Improves staff satisfaction
Conclusion
Financial and quality incentive for administration to pursue case management
• Implications for other in-hospital complex groups
• Better patient care
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Ministry of Health
