The Impact of Nursing on Trauma Patient Satisfaction: An Analysis of HCAHPS From 112,283 Patients.
Watts DD, Slivinski A, Garland JM, Kerley DR, Wilson NY, Cooper T, Howard K, Dunne J, Lieser MJ, Berg GM, Wyse RJ, Carrick MM, Fakhry SM. J Trauma Nurs. 2021 Jul-Aug 1;28(4), 219-227.
Patient satisfaction is increasingly used to evaluate clinician performance and quality of care. The most comprehensive and standardized U.S. measure of patient satisfaction is the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The HCAHPS survey has previously been used to assess trauma patient satisfaction but has never focused on the impact of trauma nurses on the patient experience. This study of Level I-IV trauma centers in a multistate hospital system evaluated patients 18 years and older admitted with at least an overnight stay. Data from surveys from 2018-2019 discharges were linked to trauma registry data. Patients were categorized as trauma per the National Trauma Data Standard, or as medical or surgical per the HCAHPS definition. Of the n=112,283 surveys from 89 trauma centers, trauma patients (n = 5,126) comprised 4.6%, surgical 39.0% (n = 43,763), and medical 56.5% (n = 63,394).
Nurses had an overwhelming impact on trauma patient satisfaction, accounting for 63.9% (p < .001) of the variation (adjusted R2) in the overall score awarded the institution; larger than for surgery (59.6%; p < .001) or medical (58.4%; p < .001) patients. Nurses had an even larger overall impact on penetrating trauma patient satisfaction, accounting for 80.6% of the variation in the overall facility score patients awarded the hospital (P < .001). A major limitation was the study lacked data concerning patient complications. The most important individual domain contributor to a facility's overall rating was "nursing communication." This study adds to the body of literature stressing the importance of nursing and communication on patient satisfaction, but the pronounced magnitude in trauma more than for medical and surgical patients is a new finding. It is posited that trauma nurses working in collaborative, highly reliable, multidisciplinary trauma team environments promote increased communication and patient satisfaction.
Center for Trauma Survivorship Improves Postdischarge Follow-up and Retention. Goldstein C, Gore A, La Bagnara S, Jacniacka-Soto IE, Sieck D, Yonclas P, Livingston DH. J Trauma Acute Care Surg. 2022 Jul 1;93(1), 118-123.
With increased trauma survivorship comes increased responsibility of trauma centers to move beyond discharge to optimize postdischarge support. Yet, trauma centers have a historically poor follow-up after discharge. This study reports one trauma center's effort, "The Center for Trauma Survivorship (CTS)," created to improve postdischarge care of severely injured trauma patients. This before and after study evaluated the effect of the center on follow-up rates in trauma patients at a large, urban Level I trauma center. Eligible patients were older than 18 years with an intensive care unit (ICU) length of stay of at least 2 days and/or a New Injury Severity Score (NISS) of at least 16 who survived to discharge. The center incorporates a trauma surgeon, physiatrist, behavioral health specialist, health care navigator, nurse practitioner, and social worker. Patients were approached during their initial hospitalization before discharge, and a CTS visit was set up in lieu of follow-up in the standard trauma clinic. Appointments and transportation were coordinated. Comprehensive screening includes a complete assessment of physical, emotional, and behavioral health. At first CTS visit, patients are screened for posttraumatic stress disorder and depression and referred to behavioral health services as appropriate. Further visits with other specialties were coordinated by the CTS, and patients were provided phone access to CTS staff.
There were 177 patients meeting CTS eligibility criteria in the PRE cohort and 119 patients meeting the CTS group criteria. The PRE and CTS cohorts were similar in age, sex, race, ethnicity, mechanism of injury, and ICU and hospital lengths of stay. A significantly higher proportion of patients followed up within the health system in the CTS cohort compared with the PRE cohort (91% vs. 73%, p < 0.001). This resulted in an average of 12 visits per patient in the CTS group compared with an average of 8 visits per patient in the PRE group. Similarly, there was more than a 50% increase in the rate of follow-up within the trauma department, with the CTS patients following up in the CTS and the PRE patients following up in trauma clinic (62% vs. 39%, p < 0.001). This study shows that trauma centers can move with intentionality beyond survival alone as a measure of success. Trauma survivorship and patient reported outcomes are the next frontiers in the trauma chain of survival.
Addressing Compassion Fatigue in Trauma Emergency and Intensive Care Settings: A Pilot Study. Beres KE, Zajac LM, Mason H, Krenke K, Costa DK. Journal of Trauma Nursing. 2022 Jul-Aug; 29(4): 210-217.
Trauma, emergency, and critical care providers are constantly at high risk for compassion fatigue which includes a loss of empathy, exhaustion, and frustration. Unfortunately, this is a something that is not widely addressed and can lead to decreased quality of patient care, compromised patient safety, and high staff turnover rates. The authors explore the feasibility of using structured debriefing sessions for nurses, nursing assistants, EMTs, EMT techs, and respiratory therapists working full time in the emergency department and the intensive care unit of an urban level II trauma center to help mitigate compassion fatigue after patient deaths. A preintervention/postintervention design was used, where participants were given a Professional Quality of Life Measure survey two weeks before and two weeks after the intervention. Structured debriefing sessions were implemented after every reported patient death over a 12-week period on the respective unit and all staff involved in the patient care were invited to participate. There were 56 employees that participated in 20 debriefings which covered nearly half of the reported deaths. The study looked at the difference in burnout, secondary traumatic stress, and compassion satisfaction among the participants.
At the closing of the study, the authors found no significant difference in burnout (M = 25.5, SD = 5.4, p =.47), secondary traumatic stress (M = 23.9, SD = 5.6, p = .99), or compassion satisfaction (M = 36.8, SD = 6.4, p = .61). They noted limitations of a small sample size, and that management was used as debriefing implementors, which may have influenced willingness to participate. There was also a high rate of employee turnover making it difficult to link the preintervention and postintervention surveys so there was a possibility of missing data. It was concluded that structured debriefing sessions can help support providers emotionally and potentially help decrease the incidence of compassion fatigue, however, there is a need for further research on the effectiveness of the intervention on a larger scale.
Prevalence and Predictors of Posttraumatic Stress Disorder, Depression and Anxiety In Personnel Working In Emergency Department Settings: A Systematic Review. Matthews LR, Alden LE, Wagner S, et al. J Emerg Med. 2022 May;62(5):617-635.
Traumatic events are more likely to occur in the emergency department than in other healthcare areas. Physical assaults, the death of a child, or exposure to injured victims of accidents can lead to burnout and other mental health conditions such as posttraumatic stress disorder (PTSD), depression, and anxiety, impairing a health care worker's ability to deal with the cognitive demands of the work.
A search was conducted over seven databases reporting an evidence and prevalence of outcomes for PTSD, depression, and anxiety for ED personnel. Included in the search were emergency physicians, nurses, health care assistants, and other support staff aged 18-70 years, employed in or currently off work from an ED setting. Of the 3251 articles, 26 were considered for the review: 5 studies (21%) reported on emergency nurses, ten studies (42%) reported on emergency physicians, and nine studies (37%) reported using a mixed sample of ED staff.
In the review of articles related to PTSD, studies examining sociodemographic variables did not find significant relationships between PTSD and marital status, race, education, or profession. Trauma-related factors identified a positive relationship between repeated exposure to traumatic events and PTSD. High levels of violence and the experience of aggression with helplessness and horror were significantly associated with PTSD. There were no significant associations between depression and sociodemographic variables of age, gender, marital status, education, profession, or income. Anxiety and sociodemographic variables of the female gender, length of work experience in EDs, and working in the public sector was found to be elevated in the three studies conducted in the European region, questioning the generalization to other ED staff.
After the review, the authors suggest the development of interventions to prevent the development of trauma-related mental health conditions, education on optimal ways of coping following exposure to trauma, and workplace safety strategies to reduce rates of assault experienced by ED personnel. Considerations should also include looking at healthcare providers in other settings.