Improving Communication with

Trauma Patients

Melissa Bantick

Quality and Patient Safety

Consultant, The Royal Melbourne

Hospital

1Gabbe, B. Sleney, J. Gosling, C. and Christie, N. (2012) ' Exploring patient

perceptions of barriers and facilitators of recovery following trauma.’ Medical

Journal of Australia, 198(3)

Our Aim

• To identify the perceptions of trauma inpatients at RMH

regarding;

– Communication

– Involvement in decision making

– Ward rounds

– General satisfaction

– Also to understand if perceptions varied across different

demographic groups; sexes, ages, major trauma, mechanism of

injury, number of trips to theatre, discharge destination and LOS

Method

• Ethics Approval

• Survey 169 Inpatients while Trauma

was the Treating Team – February to June 2013

• Paper based

– 20 questions with opportunity for free

comment

– Responses recorded on a Leichardt

Scale Strongly

• Correlated results with patient

demographics, collected from the

Royal Melbourne Trauma Registry

Inclusion/Exclusion Criteria

Inclusion criteria Exclusion criteria

Any patient admitted under the Trauma Unit Any patient sectioned under the Mental Health Act (involuntary)

Surveys responses were collected prior to discharge or prior to transfer to another treating unit for ongoing management

Any patient who has not been cleared of Post Traumatic Amnesia (PTA) prior to discharge

Glasgow Coma Score (GCS) of 15

Any patient discharged directly from the emergency department

Under 18 years of age when parent or guardian present

Any patient with a Glasgow Coma Score (GCS) of less than 15

Classification of Major Trauma

• Death after an injury

• Admission to ICU for >24Hrs

• Serious injury to two or more

ISS body systems, or ISS>15

• Urgent surgery for intracrainial,

intrathoracic or intraabdominal

injury or fixation of pelvic

fractures

Patient Demographics

Demographic Population size (RMH –

Trauma Admissions Feb-

June2013)

Survey

Sample Size (N)

Proportion

Represented

All 1334 169 12.67%

Men

Men (Major)

834

242

117

57

13.4%

23.55%

Women

Women (Major)

473

91

52

19

10.99%

20.81%

LOS >10.01days 138 35 25.63%

MVA

MBA

282

107

52

28

18.44%

26.17%

DC Destination

Rehab

272 41 11.88%

Proportions amongst demographics ranged from 4.16% (LOS<=2days) and 26.47% (High Falls)

MECHANISM OF INJURY TOTAL MAJOR NON MAJOR

MVA 52 25 27

LOW FALL 22 5 17

MBA 28 16 12

PEDAL CYCLIST 8 2 6

HIGH FALL 27 17 10

CUTTING PIERCING (ASSAULT) 3 2 1

OTHER ANIMAL RELATED 1 1 0

STRUCK BY OR COLLISION WITH OBJECT 4 0 4

STRUCK BY OR COLLISION WITH OBJECT (ASSAULT) 3 1 2

PEDESTRIAN VS CAR 6 3 3

PEDESTRIAN VS TRAM 1 0 1

STRUCK BY OR COLLISION WITH PERSON 4 0 4

UNSPECIFIED 1 0 1

HORSE RELATED 3 0 3

OTHER TRANSPORT RELATED 2 1 1

Threat to breathing - self harm 1 1 0

PEDESTRIAN VS TRAIN 1 1 0

FIRE ARM 1 1 0

Results

• Survey questions were grouped into the themes of;

– General Satisfaction

– Decision Making

– Information

– Ward Rounds

• Patient responses were analysed by grouping those that Agreed and

Strongly Agreed vs those that were Neutral, Disagree or Strongly Disagree

General Satisfaction Questions related to general satisfaction, dignity, respect and care rated highly across all

patient groups. 35 year old male cyclist, LOS 3.92days:

“The nurses provided exceptional support and care both physically and emotionally and had very positive attitudes.

Thank you all!”

56 year old female MVA, LOS 4.91 days:

“I was attended to promptly after my accident. The quality of care was excellent. Staff were patient, kind supportive and

helpful. More staff would be appreciated current staff run off their feet.”

45 year old Male Major, pedestrian, LOS 28.1 days:

“Staff always one step ahead of me, always looked after well.”

63 year old Male Major Trauma, MBA, LOS 23.05 days:

“I would recommend the trauma service to others”

General Satisfaction

General Satisfaction

• Significant differences between groups related to general

satisfaction

p-value<.05

• General satisfaction with treatment at RMH as a Trauma Patient

– 26-40 years 90.7% (N 39/40) and 41-60 years 88.5% (N 46/52) vs 61+

years 100% (N 44/44)

– MVA 98.1% (N 51/52) were more satisfied than those with a MOI High

Fall 85.2% (N 23/27)

Decision Making

• I was provided with the opportunity to be involved in decisions about

my discharge:

– Men 50.4% (59/117) less satisfied than Women 67.3% (35/52)

74 year old female low fall, LOS 7.73days: “There was not enough information provided to family about restrictions on mobility post

discharge and conflicting information about discharge plans”

45 year old female MVA, LOS 5.59: “For long distance patients try to contact family more efficiently”

Decision Making

• As much as I wanted I was provided with the opportunity to be

involved in decisions about my treatment or care:

– Men 58.1% (68/117) less satisfied than women 76.9%(40/52)

– Major Men 58.6% (34/57) less satisfied then Major Women 89.5%

(17/19)

– 16-25 years olds 80% (24/30) more satisfied than 26-40 year olds

53.5% (23/43)

• I was provided with the opportunity to be involved in decisions about

my discharge:

– Men 50.4% (59/117) less satisfied than women 67.31% (35/52)

Information

60 year old Male Major Trauma, MBA LOS 4.73 days: “On coming to after the accident lack of information results in confusion and anxiety. Patient communication

regarding injuries sometimes disregarded. No notion of patient knows best sometimes.”

41 year old Male High Fall, LOS 6.78 days: “Senior nurses felt comfortable enough to answer questions. Younger nurses less professional and confident.

Needs to be better communication to patient about time scale/sequence between team and patient.”

60 year old female MVA, LOS 1.96 days: “Better communication/liaison between different teams to avoid patient confusion.”

29 year old Female, MVA, LOS 3.76 days: “More basic information about doctors certificate ect. I had to ask many times when can I go back to work.”

24 year old Male Major, MVA LOS 9.23 days: “More specific conversations and questions rather than general. More information discussion regarding future

with rehab placements.”

• Patients felt like they had a good understanding of the

injuries they had and were provided with enough

information

• 10% felt information was withheld from them at times

• 35% reported receiving conflicting information

• 23% were frustrated by the lack of information provided

Significant differences in perceptions around

information p-value <.05 Men Women

I have a good understanding of

all the injuries I have

91.45% (107/117) 78.85% (41/52)

Major 93.10% (54/57) 73.68% (14/19)

I never received conflicting

information

Major 51.72% (30/57) Major 78.95% (15/19)

I sometimes felt that the Trauma

Team were deliberately not

telling certain things I wanted to

know

12.82% (15/117) 5.26% (1/52)

Information and number of

operations

While you were in hospital did you ever think

that the trauma team were deliberately not

telling you certain things you wanted to

know?

Percentage reported

Agree and Strongly Agree

No trips to OT (n 80) 2.5% (2)

<=2 Trips to OT (n 75) 13.3% (10)

>2 Trips to OT (n 14) 28.6% (4)

Information and LOS

Ward Rounds • Over all patients were satisfied with

ward rounds, identification of staff on

rounds, and the opportunity to ask

questions and reported that the rounds

communicated in terms they could

understand.

30 year old Male MVA, LOS 3.76days:

“My private information was shared around

the whole room.”

49 year old Male, High Fall, LOS 6.68

days:

“Try to make large teams less

intimidating”.

Limitations

• Some patients were surveyed prior to transfer to another

unit for care, however they may have been some way

from hospital discharge

• While the sample size was calculated, some smaller

demographics were still under represented in the sample

• Patients LOS <2days were under represented in the

sample

• Representation of Non English Speaking patients?

Conclusion

• Patient perceptions of care, treatment with dignity and respect and ward rounds were

positive

• Identified poor perceptions around some elements of communication decision making

and involvement in discharge planning and longer term outcomes

• Considerable differences in perceptions do exist within sub groups of patients

– Multiple trips to OT

– Men and Women

– Falls

– Discharge destination

– Length of stay

Where to from here?

• Working party to consider data and

identify actions

• Considerations: – Clinical Nurse Consultant Role

– Patient information – directed at particular

demographics

– Processes to reduce cancellations on ETBS

– Consideration of consumer engagement in

Discharge Planning Processes

– Improved communication across specialties

Thank You With thanks to Kellie Liersch, Trauma Education Coordinator,

Meinir Griffiths and staff 7SW, Leilani Johnston and staff of

7SE, Ruth Harper and staff of 3SW, RMH Trauma Registry

Staff, A/P Rodney Judson and RMH Volunteers Bill Horricks

and Gwen Morrish.