North Bristol NHS Trust​

Approved 16 September 2016. You can read other case studies.

Severn Major TraumaHealth Foundation

Quality Trauma Discharge​

UK Major Trauma Networks were launched in 2012 and have reported significantly reduced mortality in the first years of operation. North Bristol NHS Trust is the adult Major Trauma Centre for the Severn Major Trauma Network, one of two in the South West serving an adult population of 2.5 million.

In the national service specification Major Trauma Networks are mandated to deliver a system of care from pre-hospital through to rehabilitation. Whilst mortality has reduced, post discharge and rehabilitation concerns remain the most common issues identified at annual national peer review visits. The current discharge process is focused on the patient leaving hospital rather than as an opportunity to educate and facilitate enhanced recovery. Anxiety, uncertainty about provision of care post discharge and confusion about medication are frequently described at follow up as well as unscheduled healthcare attendances.

The Quality Trauma Discharge (QTD) is intended to mitigate or avoid these issues through the implementation of simple measures based on concepts described in the Re-engineered Discharge (RED) Project (Boston, USA). The delivery of a comprehensive discharge consultation with a trained trauma practitioner and pharmacy counselling, provision of a personalised discharge pack (After Hospital Care Plan- (AHCP)) and follow-up contacts are designed to reduce the identified and potential problems. These interventions are designed to educate and empower patients and their families to better manage the sometimes difficult move from hospital back to the community.  Furthermore, we feel that informed patients who are placed at the centre of their care can facilitate the seamless transition of information between specialist services and primary and secondary care.

Outcome measure Result
Number of unscheduled healthcare attendances within 30 days of hospital discharge Significant reduction in GP attendances in the QTD group compared to pre-intervention (51% vs 71%, p=0.0037)
Major Trauma Centre length of stay No change
Patient and Carer satisfaction scores Significant improvement in mean hospital rating score in the QTD group compared to pre-intervention (9.1 vs 8.2, p< 0.0001)
Patient activation measurement Increased patient activation following QTD