Jude Sleney

Patient perspectives of care in a regionalised trauma system: lessons from the Victorian State Trauma System.

Objectives: To explore injured patients’ experiences of trauma care to identify areas for improvement in service delivery.

The impact of injuries study. multicentre study assessing physical, psychological, social and occupational functioning post injury - a protocol

BackgroundLarge numbers of people are killed or severely injured following injuries each year and these injuries place a large burden on health care resources. The majority of the severely injured are not fully recovered 12-18 months later. Psychological disorders are common post injury and are associated with poorer functional and occupational outcomes. Much of this evidence comes from countries other than the UK, with differing health care and compensation systems. Early interventions can be effective in treating psychological morbidity, hence the scale and nature of the problem and its impact of functioning in the UK must be known before services can be designed to identify and manage psychological morbidity post injury.Methods/DesignA longitudinal multi-centre study of 680 injured patients admitted to hospital in four areas across the UK: Nottingham, Leicester/Loughborough, Bristol and Surrey. A stratified sample of injuries will ensure a range of common and less common injuries will be included. Participants will complete a baseline questionnaire about their injury and pre-injury quality of life, and follow-up questionnaires 1, 2, 4, and 12 months post injury. Measures will include health and social care utilisation, perceptions of recovery, physical, psychological, social and occupational functioning and health-related quality of life. A nested qualitative study will explore the experiences of a sample of participants, their carers and service providers to inform service design.DiscussionThis study will quantify physical, psychological, social and occupational functioning and health and social care utilisation following a range of different types of injury and will assess the impact of psychological disorders on function and health service use. The findings will be used to guide the development of interventions to maximise recovery post injury.

Seeking support after hospitalisation for injury: a nested qualitative study of the role of primary care

BACKGROUND In the UK, studies suggest that the transition from hospital to home after an injury can be a difficult time and many patients report feeling inadequately prepared. Patients often use primary care services after hospital discharge. These consultations provide opportunities to consider problems that patients experience and to facilitate recovery. Little is known, however, about how patients and service providers view care after hospital discharge and the role played by primary care services, specifically GPs. AIM To identify good practice and unmet needs in respect of post-discharge support for injured patients. DESIGN AND SETTING Qualitative study using semi-structured interviews at four sites (Bristol, Leicester/Loughborough, Nottingham, and Surrey). METHOD Qualitative interviews with 40 service providers and 45 hospitalised injured patients. RESULTS Although there were examples of well-managed hospital discharges, many patients felt they were not provided with the information they needed about their injury, what to expect in terms of recovery, pain control, return to work, psychological problems, and services to help meet their needs. They also described difficulty accessing services such as physiotherapy or counselling. Service providers identified problems with communication between secondary and primary care, lack of access to physiotherapy, poor communication about other services that may help patients, GP service and resource constraints, and difficulties in providing information to patients concerning likely prognosis. CONCLUSION Discharge from hospital after an injury can be problematic for patients. Changes in both secondary and primary care are required to resolve this problem.

Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study)

Objective To explore views of service providers caring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision. Design Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers’ views were elicited through semistructured interviews. Data were analysed using thematic analysis. Setting Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. Participants 40 service providers from a range of disciplines. Results Service providers described two distinct models of trauma care: an ‘ideal’ model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a ‘real’ model based on the realities of National Health Service (NHS) practice. Participants’ ‘ideal’ model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, ‘real’ care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients’ needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Conclusions Service providers envisage an ‘ideal’ model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between ‘real’ and ‘ideal’ care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of care.

The impact of injuries on health service resource use and costs in primary and secondary care in the English NHS

© The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. Background: Injuries in working age adults are common, but few studies examine NHS resource use or costs. Methods: Costing study based on a cohort of 16- to 70-year olds admitted to hospital following unintentional injury in NHS Trusts in four UK centres. Participants completed resource-use questionnaires up to 12 months post-injury. Primary and secondary care, aids, adaptations, appliances and prescribed medications were costed. Mean costs by injury type and age group and costs per clinical commissioning group (CCG) were estimated. Results: A total of 668 adults participated. Follow-up rates ranged from 77% at 1 month to 65% at 12 months. The mean cost of injuries over 12 months was £4691 per participant. Costs were highest for hip fractures (£5159), lower limb fractures (£4969) and multiple injuries (£4969). Secondary care accounted for 87% of mean costs across all injuries and primary care for 10%. The mean cost per CCG was £7.3 million (range £1.8 million-£25.6 million). The total cost across all English CCGs was £1.53 billion. Conclusions: Unintentional injuries in working age adults result in high levels of NHS resource use and costs in the year following injury. Commissioning effective injury prevention interventions may reduce these costs.

Qualitative insights into patients experiences of injury: the burden of injury

The UK Burden of Injury Study was a major study that aimed to understand the impacts of unintentional injury on people. Both quantitative and qualitative measures were used. This paper explores the patients experience of injury, its impact on their lives from a qualitative perspective. In-depth interviews were carried out among 89 participants of different ages, genders and employment status who had suffered from a variety of different injuries across different settings, presenting to several A&E departments. Over half of the participants experienced some emotional impact from their injury. Many participants, often older, experienced some loss of confidence as a result of their injury. Adequate, timely information was an important concern for participants during their care. Financial and employment issues had a greater impact on those participants that were self employed. Support from friends, family and neighbours were regarded by participants as extremely important especially during the first few weeks/months after leaving hospital. The research confirms the importance of social support for facilitating recovery from injury. The role of information seems very important to patients throughout the process of treatment, discharge and rehabilitation. For some patients it was clear that their injury could lead to mental health problems when the injury had been life changing this has implications for the support of people after discharge. This research also affirms the importance of injury prevention to avoid these major impacts on peoples lives.

The Advocacy In Action Study (AIAS): a randomised controlled trial of an advocacy package directed at elected councillors to improve pedestrian safety in high risk deprived neighbourhoods

Objectives To determine whether an advocacy package aimed at elected councillors resulted in improved pedestrian safety in deprived areas. Methods Cluster randomised controlled trial involving 617 councillors from 239 wards in England and Wales, from deprived areas with high pedestrian injury rates. The intervention group were provided with information and maps on casualty sites, numbers and effective interventions. Outcomes were measured at 3, 18 and 27 months. Results The intervention improved short-term outcomes such as increasing councillors interest in child accident prevention (RR 1.09, 95% CI 1.03 to 1.16), increasing belief they could take action to help prevent child accidents (RR 1.36, 95% CI 1.16 to 1.61), and particularly on pedestrian safety (RR 1.55, 95% CI 1.19 to 2.03). By 18 months 63% of intervention councillors reported involvement in supporting new pedestrian road safety schemes. However, pedestrian safety measure changes were statistically non-significant: difference in road length traffic calmed (0.07 km, 95% CI: −0.07 to 0.20); proportion of schools with 20 mph zones (RR 1.47, 95% CI: 0.93 to 2.32), Safe Routes to School (RR 1.34, 95% CI: 0.83 to 2.17; or proportion providing practical pedestrian training (RR 1.23, 95% CI: 0.95 to 1.61). Implications The AIAS intervention succeeded in raising councillors awareness of and interest in pedestrian safety but failed to improve engineering or educational measures of pedestrian safety. Longer term supported advocacy may be needed for change.

The UK burden of injuries study (UKBOI)

Objectives The UKBOI study was designed to quantify important components of the population burden of injury in the UK. Methods A mixed methods study incorporating a multi-centred prospective cohort of injured individuals; extrapolation of patient reported outcomes to population metrics using routine data from emergency departments (ED), hospital discharge registers and mortality data; calculation of Disability Adjusted Life Years (DALYs) using Global Burden of Diseases methodology and estimated indirect costs; and the calculation of direct medical costs. Results The study recruited 1517 injured individuals. Estimated numbers (and rates per 100 000) for UK population extrapolations were 750 999 (1240) for hospital admissions, 7 982 947 (13 339) for emergency department attendances, and 22 185 (36.8) for injury related deaths, in the financial year 2005/6. An estimated 1 574 000 DALYs were lost from injuries occurring in that year, with 80% due to Years Lived with Disability (YLDs) and 20% from Years of Life Lost (YLLs). Some 10% of DALYs lost were due to YLDs occurring within 12 months post injury and 70% due to lifelong injuries. Direct medical costs were estimated at 482 million for ED visits and 2.15 billion for inpatient stays, with indirect costs of up to 31.5 billion. The qualitative study with 90 participants revealed many additional negative consequences for individuals, family and society. Implications The high population burden and costs associated with injuries in the UK demonstrates the need for sustained policies and interventions in support of prevention.