Quality trauma discharge North Bristol NHS Trust

Patients often feel anxious, confused about medication and uncertain about their ongoing care when they are discharged from hospital following major trauma.

The discharge process is often focused on the patient leaving hospital, rather than being seen as an opportunity to provide information and support rehabilitation.

Quality trauma discharge (QTD) is a North Bristol NHS Trust project that introduced a comprehensive discharge package for major trauma patients at Southmead Hospital, adapted from the re-engineered discharge (RED) project developed in Boston, USA. The aim was to improve patient and carer satisfaction, and reduce unscheduled health care attendances.

The package included a detailed discharge consultation with a trained trauma practitioner, pharmacy counselling, a tailored after hospital care plan (AHCP) and post discharge follow-up. The intervention was gradually introduced to allow real-time refinement and learning. This crucial process guided adaptations such as the transition to a patient-controlled electronic version of the AHCP – a ‘future-proof’ format reflecting society’s demand for online resources and instant messaging.

Measurement of key outcomes revealed that, compared to before the intervention, there was a significant (20%) reduction in unscheduled GP attendances in the 30 days following discharge. Patient and carer satisfaction improved (evidenced by a significant increase in mean hospital rating score) and 39% more patients were activated to manage their own health care needs.

An unanticipated benefit from the intervention was improved patient safety and avoidance of harm – for example, through effectively signposting patients to appropriate care settings via online messaging and telephone helplines.

The challenge of effectively delivering this intervention in a pressured and resource-limited environment was overcome by regular team meetings and ongoing feedback, which opened communication channels and established clear lines of managerial and clinical support. QTD is now viewed as an integral part of the trauma service, educating and empowering patients and their families to better manage the sometimes difficult move from hospital back to the community.

This Innovating for Improvement project ran from the beginning of May 2015 until the end July 2016.

Downloads

• Major Trauma – More lives saved, NHS North Bristol NHS Trust

Contact information

For more information about this project, please contact Professor David Lockey, Consultant and Severn Trauma Network Director, North Bristol NHS Trust.