Feasibility of a Trauma Quality of Life Follow up Clinic.

BACKGROUND: Little effort has been made to address long-term quality of life (QOL), chronic pain(CP), post-traumatic stress disorder (PTSD), and functional disability in trauma survivors. This quality initiative was developed to determine feasibility of a coordinated, comprehensive, patient-centered follow-up clinic for those at risk for poor long-term outcomes. METHODS: A convenience sample from 649 hospitalized trauma patients at a Midwestern level 1 trauma center between 2/2018 and 8/2018 was screened for risk of PTSD and CP. 36 patients were randomized into a standard follow-up clinic (SOC) (2-week post-discharge surgical clinic) or a new trauma quality of life clinic (TQOL). The TQOL was developed to provide comprehensive care to patients at high risk for PTSD (Injured Trauma Survivor Score >/=2) and/or CP (discharge pain score >/=4). TQOL included a nurse practitioner or surgeon(NP/MD), psychologist, social worker, and physical therapist at one-week post discharge. All providers saw the patient independently, developed a care plan collaboratively, and communicated the plan to the patient. The SOC involved a visit only with an NP/MD. Measures of pain, PTSD, depression, QOL, physical functioning, and life satisfaction were completed at time of the TQOL/SOC or over the phone. RESULTS: There were no differences in demographics, readmissions, or emergency department visits after discharge between groups. However, no show rates were almost twice as high in SOC (40%) compared to TQOL (22%) and those in TQOL completed 23 additional psychology visits versus one psychology visit in SOC. This clinic structure is feasible for high risk patients and TQOL patients demonstrated improved engagement in their care. CONCLUSIONS: A comprehensive multidisciplinary TQOL addressing issues affecting convalescence for trauma patients at high risk for developing PTSD and CP can improve follow-up rates to ensure patients are recovering successfully. LEVEL OF EVIDENCE: IV, therapeutic.