Aim The purpose of the study was to formally identify trauma care delivery problems at the study institution, implement a solution in the form of trauma case management (TCM), and measure the effect of TCM on staff satisfaction, clinical coding accuracy and patient outcomes, using practice-specific outcome variables such as in-hospital complication rates, length of stay, resource use and allied health service intervention rates. This research also aimed to make a unique contribution to the international trauma literature by addressing the lack of any evidence specifically measuring the impact of trauma case management intervention. Methods St George Hospital is a 600 bed urban Teaching Hospital of the University of NSW. It is a designated Trauma Centre, seeing around 200 severely injured patients and around 2500 injury admissions per year. A series of focus groups and a staff satisfaction survey identified perceived problems associated with trauma care, and a trauma case management program was implemented. A preliminary study was conducted with positive results and funding was obtained to provide TCM seven days a week to all trauma patient admissions. A larger clinical trial was conducted and data from 754 patients were collected over fourteen months after TCM was introduced at the study hospital. These data were compared with 777 matched patients from the previous 14 months as a control group. An audit was conducted on trauma patient clinical coding using the daily progress record kept by the trauma case manager. The data were analysed with SPSS. The statistical tests used were Mann-Whitney U, chi-squared (2) logistic regression and generalised linear models. Results Focus groups and the staff satisfaction survey identified communication and coordination as the main problems associated with trauma care delivery. Following the initial implementation of the program, staff support for TCM was overwhelming. TCM greatly improved the rate of and time to Allied Health intervention (p<0.0001). Results demonstrated a decrease in the occurrence of deep vein thrombosis (p<0.038), coagulopathy (p=0.041) and respiratory failure. A reduced hospital length of stay (LOS), particularly in the paediatric (p<0.05) and 45 - 64 years age group was noted. There were 6621 fewer pathology tests performed (p<0.0001) and the total number of bed days was 483 days less than predicted from the control group. Many hospital clinical coding errors and omissions were highlighted by the TCM record comparison. The use of TCM records resulted in Twenty eight percent of recoded records having their Australian national diagnostic related group (AN-DRG) changed, which resulted in the identification over $39,000 in unidentified funding. Conclusion TCM improves staff satisfaction, communication and clinical coding accuracy. The introduction of TCM improved the efficiency and effectiveness of trauma patient care in our institution. This initiative demonstrates that TCM results in improvements to quality of care, trauma patient morbidity, financial performance and resource use. This research makes an important and original contribution to the international trauma literature by providing the results of a clinical trial formally measuring the impact of trauma nursing case management intervention.
| Identifer | oai:union.ndltd.org:ADTP/215675 |
| Date | January 2006 |
| Creators | Curtis, Kathleen Anne, Public Health & Community Medicine, Faculty of Medicine, UNSW |
| Publisher | Awarded by:University of New South Wales. School of Public Health and Community Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Kathleen Anne Curtis, http://unsworks.unsw.edu.au/copyright |
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