Exploring geriatric trauma unit experiences through patients' eyes: a qualitative study.

INTRODUCTION: The surgical management of older patients is complex due to age-related underlying comorbidities and decreased physiological reserves. Comanaged care models, such as the Geriatric Trauma Unit, are proven effective in treating the complex needs of patients with fall-related injuries. While patient-centered care is an important feature of these comanaged care models, there has been minimal research dedicated to investigating the patient experience within Geriatric Trauma Units. Therefore, it remains uncertain whether the Geriatric Trauma Unit's emphasis on a patient-centered approach truly manifests in these interactions. This study explores how patients with fall-related injuries admitted to a Geriatric Trauma Unit perceive and experience patient-centered care during hospitalization. METHODS: This qualitative generic study was conducted in three teaching hospitals that integrated the principles of comanaged care in trauma care for older patients. Between January 2021 and May 2022, 21 patients were interviewed. RESULTS: The findings highlight the formidable challenges that older patients encounter during their treatment for fall-related injuries, which often signify a loss of independence and personal autonomy. The findings revealed a gap in the consistent and continuous implementation of patient-centered care, with many healthcare professionals still viewing patients mainly through the lens of their injuries, rather than as individuals with distinct healthcare needs. Although focusing on fracture-specific care and physical rehabilitation aligns with some patient preferences, overlooking broader needs undermines the comprehensive approach to care in the Geriatric Trauma Unit. CONCLUSION: Effective patient-centered care in Geriatric Trauma Units requires full adherence to its core elements: patient engagement, strong patient-provider relationships, and a patient-focused environment. This study shows that deviations from these principles can undermine care, emphasizing the need for a holistic approach that extends beyond treating immediate medical conditions.

"Peas in a Pod": Clustering minorly injured trauma patients together during their hospitalization results in decreased hospital costs and fewer inpatient complications.

BACKGROUND: Trauma patient care is complex. Clustering these patients within the hospital seems intuitive. This study's purpose was to explore the benefits of trauma patient clustering, hypothesizing these patients will have decreased costs and better outcomes. METHODS: This was an analysis of all adult (18-99 years) trauma patients admitted from 1/2017-1/2019 without an intensive care unit stay. Patients were grouped into those admitted to the trauma unit (TU) versus non-trauma units (NTU). Outcomes evaluated between groups were baseline demographics, direct costs, complication rates (using our TQIP registry), and discharge location. T-test, median test, and chi squared test were used. Linear regression was performed. Significance was set at p < 0.05. RESULTS: 1481 patients (684 TU and 797 NTU) were analyzed. TU patients were younger. Injury Severity Score, mortality, and hospital length of stay were similar between groups. Direct hospital costs were decreased for TU patients ($4941(±$4740) versus $5639(±$4897), p = 0.006). Fewer TU patients experienced inpatient complications (7.8% versus 13.5%, p < 0.001). More TU patients were discharged to home (78.9% versus 73.8%, p = 0.02). Linear regression analysis demonstrated admission to NTUs predicted a direct cost increase of $766.35 (p < 0.001). CONCLUSIONS: Clustering minorly injured trauma patients on a dedicated unit resulted in reduced costs, decreased complications, and higher likelihood for discharge to home.

Suicide and self-injury outcomes for patients with comorbid psychiatric and physical health conditions.

Suicide is a transdiagnostic public health issue that affects nearly all psychiatric disorders, individuals without a mental health diagnosis, and individuals with physical health issues. We assessed the relationship between these variables and suicide outcomes using a novel epidemiological research paradigm. Data were collected from the National Trauma Data Bank. Participants included patients admitted to trauma units for suicide and self-injury (n = 13,422). Patients were classified to one of four comorbid condition groups: no comorbidity, comorbid physical condition, comorbid major psychiatric condition, or multimorbidity (comorbid physical and psychiatric conditions). Multivariable logistic regression measured associations between comorbid condition and mortality and multivariable linear regression measured associations between comorbidity and injury severity. Mortality in patients with physical health comorbidity was not significant, but patients with psychiatric comorbidity or multimorbidity had significantly lower mortality than patients without either. No association between injury severity and comorbidity was detected. There were no differences in suicide mortality for individuals with a physical health comorbidity, but mortality was lower for individuals with a comorbid major psychiatric illness or multimorbidity. Since physical health conditions and psychiatric illness are associated with eventual suicide mortality, prevention strategies could target these populations at trauma units for suicide and self-injury admissions.

Substance use and suicide outcomes among self-injured trauma patients.

BACKGROUND: Research indicates alcohol (AUD) or substance (SUD) use disorders and acute alcohol or drug use serve as risk factors for suicidal behaviors and death both distally and proximally to a suicidal event. However, limited research has investigated these relationships among medically serious suicide attempters at the time of injury without relying on cohorts of substance users only or by examining suicide decedent characteristics. METHODS: Data were collected from the National Trauma Data Bank (NTDB) for 2017. The sample comprised patients who engaged in suicidal and self-injurious acts that were medically serious enough to require trauma admission and were tested for alcohol (N = 9,196) or drug (N = 8,121) exposure upon admission. Logistic regression determined relationships between acute alcohol/substance use, presence of AUDs and SUDs and suicide mortality risk, while linear regression evaluated substance conditions and injury severity and length of stay (LOS). RESULTS: AUDs (OR = 0.59[0.42-0.83]) and SUDs (OR = 0.66[0.48-0.90]) had reduced odds of death but increased LOS (ß = 1.7, p < .001; ß = 0.82, p = .024). Blood alcohol concentration (BAC) was positively associated with reduced odds of death (OR = 0.20[0.06-0.61]), injury severity (ß = -5.3, p < .001), and LOS (ß = -7.5, p < .001). Presence of cocaine (ß = -0.80, p = .044) and opioids (ß = -1.4, p < .001) were associated lower injury severity, while MDMA (ß = 3.6, p = .016) and methamphetamine (ß = 1.5, p = .025) were associated with increased injury severity. CONCLUSIONS: While higher BAC may be associated with lower odds of mortality during a single high-risk suicide event, substance users may be at increased risk for worse outcomes over time. Targeted interventions should be considered to interrupt and develop healthy alternatives for survivors with substance use conditions.

Introduction of a virtual trauma meeting in response to COVID-19.

INTRODUCTION: The COVID-19 pandemic has had a huge impact on all our lives, both personally and professionally, and in many ways has been a catalyst for change. Limitations on social gathering have called the wisdom of a conventional trauma meeting into question. We have initiated our virtual trauma meeting and report our early results. MATERIALS AND METHODS: Daily morning trauma meetings are now conducted online. Following instigation, we collated the results of a feedback form completed online to assess the relative merits of a virtual trauma meeting. RESULTS: There were 27 responses received to the electronically administered virtual trauma meeting evaluation survey, from a range of trauma and orthopaedic department personnel. There were no concerns regarding patient safety or decision making and, apart from the quality of the audio (63% dissatisfied or very dissatisfied) positive feedback outweighed negative feedback in every category. At 74%, the majority of respondents were satisfied or very satisfied overall with the virtual trauma meeting. CONCLUSION: Trauma meetings can be safely conducted in a virtual environment with high standards of patient care maintained. Virtual trauma meeting offers service enhancements such as early subspecialty input and enhanced cross-site communication and rapid solution development to logistical difficulties. Adapting to conference call etiquette will enhance user experience and opportunity for training opportunities, but adequate investment in high-quality equipment is essential.

The London Major Trauma Network System: A Literature Review.

Trauma is one of the leading causes of death and disability worldwide and is a major global public health problem. The provision of trauma care has been substandard in England and Wales prior to the implementation of an inclusive major trauma network system in London in 2010 and subsequently across the rest of England two years later. The implementation of the London trauma system has brought about improvements to the delivery of trauma care by decreasing the overall morbidity and mortality significantly. This framework encompasses the collaboration of emergency services, designated Major Trauma Centres (MTCs), Trauma Units (TUs) and community providers which have been optimized with the expertise and resources to provide the best outcomes for major trauma patients. Specific triage protocols, consultant-led trauma service and on-the-spot access to radiology services and operating theatres have played a pivotal role in the improvement of trauma care. In spite of several strengths, however, the London major trauma network system is by no means without its limitations. The emergence of the new coronavirus disease 2019 (COVID-19) pandemic has created major barriers to the smooth running of trauma services by exhausting resources due to infection control measures, reduced theatre space and re-deployment of medical staffs. In addition, the cancellation of elective surgeries has impacted directly on the training of surgical trainees by leaving them with significantly reduced surgical exposure. As a results of this ever changing surgical landscape, a need to urgently review these traditional surgical training methods with a view to modernize the curriculum. Although the London trauma system has evolved significantly since its implementation, its limitations should be recognized and addressed to enhance performance and improve patient outcomes.

Pattern and Trend of Injuries Among Trauma Unit Attendants in Upper Egypt.

BACKGROUND: Injury is a growing public health problem worldwide. Deaths due to injuries account for 10% of the world's mortality. More than 90% of the world's injury deaths occur in low and middle income countries. In Egypt, injury is a hidden epidemic and its related deaths are misclassified due to lack of accurate national data. Furthermore, as a research problem it has also been largely ignored in developing countries. OBJECTIVES: To determine the pattern and trend of injury from January 2002 to December 2009 among attendants at trauma unit in Assiut university hospital in Upper Egypt. PATIENTS AND METHODS: A descriptive retrospective study was conducted at the trauma unit in Assiut university hospital in Upper Egypt. All registered injuries during January 2002 to December 2009 were included in the study. RESULTS: During January 2002 to December 2009, 213835 injured cases were admitted to the trauma unit. The number of attendants increased every year from 9.3% from the total cases in all study period in 2002 up to 15.3% in 2009 with a statistically significant difference (P = 0.000). Young adults aged 20 - 29 years were the most common group affected by injuries (22.2%). Male to female ratio was 3:1. Falls represent one half of injuries (49.6%) from all attended cases, followed by exposure to inanimate mechanical forces (19.5%) and transport accidents (18.3%). Falls were ranked as the leading cause of injuries, while transport accidents were the second cause in 2007 - 2009. CONCLUSIONS: Trauma in Upper Egypt is an under-recognized problem, which requires prioritized attention. Increasing the awareness of community, making policies and establishment of a trauma system are important to decrease the burden of injuries.

Orthopaedic nursing challenges in poly-traumatised patient management: A critical analysis of an Orthopaedic and Trauma Unit.

INTRODUCTION AND BACKGROUND: Trauma is the most frequent cause of death in people under 40 years old. It is an important problem not only because of the high mortality but also because of the consequential disability that can lead to serious economic consequences. STUDY AIMS: This descriptive, comparative study investigates the definitive management of poly-traumatised patients in an Italian Orthopaedic Ward in order to highlight its strengths and weaknesses in comparison with the most recent literature. This has led to the development of a pre-established algorithm for evaluation, preventive care and management of the poly-trauma patient and a flow-chart for improved patient care. RESEARCH METHODS: A five-step observational and exploratory approach was employed in this study which critically analysed the nursing management of 60 multiple trauma patients admitted to our Orthopaedic Unit from April 2013 to October 2014. RESULTS: The findings highlight the need for adherence to plans of care, which can be approached by a shared management of poly-trauma patients that involves the medical team, the patient and his family/caregiver. DISCUSSION: The protocols and guidelines in use in our Orthopaedic and Trauma Unit are in line with European standards, although there is still margin for improvement. The study has led to the development of an algorithm that allows health professionals to have reference values for the care of polytrauma patients. CONCLUSIONS AND RECOMMENDATIONS: This study demonstrates the use of theoretical and practical tools for the evaluation and management of poly-traumatised patients during their hospital stay. We recommend the use of both proposed tools: the general algorithm and the flow-chart for the management of the poly-trauma patient, as they allow identification of barriers and facilitators related to the implementation of international guidelines, currently well-defined for Emergency Departments but not yet for Orthopaedic Units.

The impact of the Major Trauma Network: will trauma units continue to treat complex foot and ankle injuries?

INTRODUCTION: April 1st 2012 saw the introduction of National Trauma Networks in England. The aim to optimise the management of major trauma. Patients with an ISS≥16 would be transferred to the regional Major Trauma Centre (level 1). Our premise was that trauma units (level 2) would no longer manage complex foot and ankle injuries thereby obviating the need for a foot and ankle specialist service. METHODS: Retrospective analysis of the epidemiology of foot and ankle injuries, using the Gloucestershire trauma database, from a trauma unit with a population of 750,000. Rates of open fractures, complex foot and ankle injuries and requirement for stabilisation with external fixation were reviewed before and after the introduction of the regional Trauma Network. Secondly, using the Trauma Audit & Research Network (TARN) database, all foot and ankle injuries triaged to the regional Major Trauma Centre (MTC) were reviewed. RESULTS: Incidence of open foot and ankle injuries was 2.9 per 100,000 per year. There were 5.1% open injuries before the network and 3.2% after (p>0.05). Frequency of complex foot and ankle injuries was 4.2% before and 7.5% after the network commenced, showing no significant change. There was no statistically significant change in the numbers of patients with complex foot and ankle injuries treated by application of external fixators. Analysis of TARN data revealed that only 18% of patients with foot and ankle injuries taken to the MTC had an ISS≥16. The majority of these patients were identified as requiring plastic surgical intervention for open fractures (69%) or were polytrauma patients (43%). Only 4.5% of patients had isolated, closed foot and ankle injuries. CONCLUSION: We found that at the trauma unit there was no decrease in the numbers of complex foot and ankle injuries, open fractures, or the applications of external fixators, following the introduction of the Trauma Network. These patients will continue to attend trauma units as they usually have an ISS<16. Our findings suggest that there is still a need for foot and ankle specialists at trauma units, in order to manage patients with complex foot and ankle injuries.

Piloting a medical student observational experience with hospital-based trauma chaplains.

INTRODUCTION: Medical students have typically received relatively modest training in approaches for engaging the concerns of patients and families facing life-threatening situations and terminal illnesses. We propose that medical students would perceive benefits to their communication skills, understanding of the role of the chaplain, and knowledge of emotional and spiritual needs of grieving patients and families after shadowing hospital-based trauma chaplains whose work focuses on emergency department traumas and intensive care units. METHODS: The authors developed a pilot program in which medical students shadowed a trauma chaplain during an on-call shift in an urban level 1 trauma center. Students subsequently completed an evaluative survey of their experience. RESULTS: Of 21 participants, 14 (67%) completed the questionnaire. Students observed an average of 1.50 traumas and 3.57 interactions with patients or families. One-third of the students witnessed a death. More than 90% of respondents agreed or strongly agreed that (1) the program provided them with a greater understanding of how to engage patients and families in difficult conversations; (2) they learned about the chaplain's role in the hospital; and (3) the experience was useful for their medical education, careers, and personal development. About two-thirds (9/14) perceived that they learned how to discuss spirituality with patients and families. All recommended the experience be part of the medical school curriculum. DISCUSSION: Observational experiences with hospital-based trauma chaplains might be an effective nondidactic approach for teaching medical students effective communication with patients and families, collaboration with chaplains, and spirituality in patient care.

Hospitalized injuries and deaths in a trauma unit in upper Egypt.

CONTEXT: It is predicted that injuries will be among the top 20 leading causes of death worldwide by 2030. In Egypt, injuries burden is significant as it was the fifth leading cause of death in 2004. Also, it's considered as a hidden epidemic due to under-reporting. AIMS: To identify the patterns of hospitalized injury cases at Trauma Unit in Assiut University Hospitals and to provide an indication about who are at increased risk of hospitalization or death due to injury. SETTINGS AND DESIGN: A descriptive retrospective study. MATERIALS AND METHODS: Registered data of all hospitalized injuries from January 2002 to December 2009 at Trauma Unit of Assiut University Hospitals in Upper Egypt were included. STATISTICAL ANALYSIS: Advanced statistical package for social sciences (SPSS) program version 16 (IBM Corporation - http://www.spss.com) was used for data analysis. Descriptive statistics and tests of significance were used. P value was considered statistically significant when it was less than 0.05 and highly significant when it was less than 0.001. RESULTS: Admitted cases of attended injuries were (31.8%). Most admissions were below the age of 30 years (58.4%). Male to female ratio was 3:1. Falls were the most common injuries (43.6%), followed by transport accidents (31.1%). More than half of deaths (56.4%) were due to transport accidents. Transport accidents, falls, interpersonal violence and gunshot injuries had an early ranking throughout the study period. CONCLUSION: Road traffic injuries, falls and violence are areas of priority in preventive strategies. Paying special attention for young adults is recommended.