From the Division of Trauma and Acute Care Surgery, Department of Surgery (E.A.B., A.B., A.S., R.L., L.H., S.C., J.C., C.T., T.d.R.-C., M.E.S.), and Comprehensive Injury Center, Medical College of Wisconsinn (T.d.R.-C.), Milwaukee, Wisconsin.
J Trauma Acute Care Surg. 2024 Jul 1;97(1):134-141. doi: 10.1097/TA.0000000000004299. Epub 2024 Mar 18.
BACKGROUND: Persons of low socioeconomic status are overrepresented in the firearm injury patient population and may experience challenges in accessing complex outpatient health systems. Consequently, outpatient care for these patients is plagued by poor follow-up and increased emergency department (ED) utilization. We developed a Post Discharge Care Team (PDCT) consisting of a dedicated trauma nurse navigator and medical social worker to bridge the gap between hospital discharge and outpatient care to improve recovery. METHODS: Adult firearm injury survivors admitted to the trauma service were randomized 1:1 to receive either PDCT services or standard of care (SOC) workflows. The PDCT nurse provided education and set expectations regarding injuries, wound care, and outpatient follow-up. The PDCT social worker performed a comprehensive assessment to identify concerns including housing and financial instability, food insecurity, or transportation issues. The primary outcome was ED utilization, with secondary outcomes including readmissions and overall health care costs compared between groups. RESULTS: In the first 6 months of the study, a total of 44 patients were randomized to PDCT and 47 to SOC. There were 10 patients who visited the ED in the PDCT group compared with 16 in the SOC group ( p = 0.23) for a total of 14 and 23 ED visits, respectively. There were 14 patients in the PDCT and 11 patients in the SOC groups who were readmitted ( p = 0.31), but the PDCT group was readmitted for 27.9 fewer hospital days. After accounting for programmatic costs, the PDCT had a hospital savings of $34,542.71. CONCLUSION: A collaborative, specialized PDCT for firearm injury survivors consisting of a dedicated trauma nurse navigator and medical social worker decreased outpatient ED utilization, readmission days, and was cost effective. Trauma centers with high volumes of penetrating trauma should consider a similar model to improve outpatient care for firearm injury survivors. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.
背景：社会经济地位较低的人在火器伤患者人群中所占比例过高，他们可能在获得复杂的门诊医疗系统方面面临挑战。因此，这些患者的门诊护理受到不良随访和急诊部（ED）利用率增加的困扰。我们组建了一个出院后护理团队（PDCT），由专门的创伤护士导航员和医务社工组成，以弥合医院出院和门诊护理之间的差距，改善康复效果。
方法：将接受创伤服务的成年火器伤幸存者随机分为 PDCT 服务组或标准护理（SOC）工作流程组，比例为 1:1。PDCT 护士提供有关伤害、伤口护理和门诊随访的教育，并设定预期。PDCT 社工进行全面评估，以确定住房和财务不稳定、粮食不安全或交通问题等方面的问题。主要结果是 ED 利用率，次要结果包括两组之间的再入院率和总体医疗保健费用。
结果：在研究的前 6 个月，共有 44 名患者被随机分配到 PDCT 组，47 名患者被分配到 SOC 组。PDCT 组有 10 名患者到 ED 就诊，SOC 组有 16 名患者（p=0.23），分别为 14 次和 23 次 ED 就诊。PDCT 组有 14 名患者和 SOC 组有 11 名患者再次入院（p=0.31），但 PDCT 组再次入院的天数减少了 27.9 天。计入项目成本后，PDCT 为医院节省了 34542.71 美元。
结论：由专门的创伤护士导航员和医务社工组成的合作、专门的火器伤幸存者 PDCT 降低了门诊 ED 利用率、再入院天数，并且具有成本效益。有大量穿透性创伤的创伤中心应考虑类似的模式，以改善火器伤幸存者的门诊护理。
证据水平：治疗/护理管理；III 级。
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