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2017-1 Comprehensive Trauma Survivor Support

BRIEF STATEMENT

Each year trauma accounts for 41 million emergency department visits and 2.3 million hospital admissions across the nation; approximately 20-40 percent of these survivors experience high levels of posttraumatic stress disorder and/or depressive symptoms. The American Trauma Society believes that comprehensive patient centered trauma care includes a commitment to systematically addressing trauma survivors’ psychosocial needs both in the hospital and during recovery, and the implementation of peer support programs connecting patients and families to each other.

 

ATS Position Statement – 2017-01

Comprehensive Trauma Survivor Support

 

Traumatic injuries affect a diverse group of people ranging in ages, health conditions and cultural backgrounds. Moreover, a large segment of this group is comprised of otherwise young, healthy, individuals, whose lives get disrupted in significant ways, potentially limiting their productivity for years to come.

Additionally, approximately 20–40 percent of all injured trauma survivors experience high levels of posttraumatic stress disorder (PTSD) and/or depressive symptoms as a result of their injuries. Similarly, research shows that family members and caregivers of injured patients can also experience comparable stressors and symptoms during the recovery period and beyond.   Many patients and families are not treated for PTSD and depression and the resultant untreated conditions are often associated with increased health care and societal costs, which affect patients, their family members and society as a whole.

Patient centered care emphasizes high quality, individually-tailored care focusing on patients rather than diseases.  Research shows that an improved patient-provider relationship leads to an improved experience of care and better clinical outcomes.  In this system, families and friends are an essential part of the team. Information is freely shared and all are encouraged to participate in decisions and care. Injured patients may not be able to understand or process the information provided in the trauma center so a trusted family member or friend not only provides emotional and physical support, but can also help the patient understand the clinicians’ diagnoses and instructions.

 

Comprehensive care for trauma patients includes a commitment to returning the patient to society with the maximum physical and psychological function possible consistent with his or her injuries. Such an outcome requires caregivers to provide timely and clear information, practice patient-centered care, and provide extensive psychosocial support services as well as access to resources that decrease isolation and facilitate patient and family healing post-discharge.

 

Peer support which includes connection to a similarly impacted trauma survivor (peer) to help the patient adapt to their new circumstances is another valuable tool that can be used to provide psychological support to trauma survivors.  This can be provided locally or through a national network such as the ATS Trauma Survivors Network (TSN).  

 

In order to accomplish the goal of comprehensive care, psychological as well as physical, each trauma survivor and family would ideally be connected to a qualified, knowledgeable healthcare professional dedicated to meeting patient and family psychosocial needs.  This person would prioritize these concerns and ensure that efforts are made to address them.

 

The ATS believes the goals of Trauma Centers, as they practice patient centered care, should include:

  • Screen patients for psychosocial distress, including, but not limited to PTSD, depression, and social isolation following discharge.
  • Implement peer support programs that connect patients and families to each other with a focus on providing opportunities to learn and grow with others facing similar challenges.
  • Provide opportunities for patients and families to volunteer their time to
      • Engage in supportive activities with trauma survivors in the hospital.
      • Educate providers and the community regarding their trauma experiences.
      • Engage in supportive activities for professional staff.
  • Provide patients and family members demonstrating a need for psychosocial support with
      • Supportive counseling in the hospital.
      • Referrals and linkages to community resources.
      • Information regarding support and educational opportunities available in the hospital. 
  • Distribute print materials to educate patients and family members regarding the hospital system, trauma diagnoses and treatments.
  • Provide supportive education to trauma family members in the intensive care units regarding the trauma care team, trauma care system and processes, etc.
  • Ensure patients and family members have access to self-management trauma recovery classes, either online or in person.
  • Consider hiring and/or training a professional dedicated to the psychosocial care of the trauma patient and family, as well as developing programs supporting their recovery. This programming would require a professional with:
      • Strong inter-personal skills and the capability to network with various partners across the hospital and the community.
      • Support and task group leadership experience.
      • Excellent teaching, management, and training skills, preferably with adults, volunteers, and groups of staff.
      • Impeccable communication skills including strong writing and presentation skills.
      • Proficiency in program development, coordination and management.
      • Strong organizational skills and self-direction.
      • Expertise in working with the press and performing media interviews.
      • Consider requiring that this professional possess the following educational background:
        • Masters prepared in one of the following health-related fields:
          • Mental health, such as social work, psychology, or counseling.
          • Health education.
          • Other health profession (e.g. Occupational Therapy/Physical Therapy/Speech Language Therapy, Nursing) with a focus on mental health. 

 

Resources

  • Committee on Trauma American College of Surgeons. Resources for Optimal Care of the Injured Patient 2014. American College of Surgeons; Chicago, IL: 2014
  • Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011. (Available on www.IHI.org)
  • Newcomb AB, Hymes R. Life interrupted: the trauma caregiver experience. Journal of Trauma Nursing (2017); 24(2):125-133.
  • Bradford AN, Castillo RC, Carlini AR, Wegener ST, Teter H, MacKenzie EJ (2011). The Trauma Survivors Network: Survive. Connect. Rebuild. Journal of Trauma and Acute Care Surgery, 70(6); 1557-1560.
  • nternational Alliance of Patients' Organizations (2016). "Declaration on: Patient-Centered Healthcare" (PDF). iapo.org.uk. Retrieved 14 Oct 2016.
  • Zatzick DF, Rivera FP, Nathans AB, Jurkovich GJ, Wang J, Fan MY, Russo J, Salkever DX, Mackenzie EJ. A Nationwide US Study of Post-Traumatic Stress after Hospitalization for Physical Injury. Psychological Medicine, 2007
  • Zatzick DF, Jurkovich GJ, Rivera FP, Russo J, Wagner A, Wang J, Dunn C, Lord SP, Petrie M, OConnor SS, Katon W. A Randomized Stepped Care Intervention Trial Targeting Posttraumatic Stress Disorder for Surgically Hospitalized Injury Survivors. Annals of Surgery, Volume 257, Number 3, March 2013
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