Patient and organisational perspectives of initial trauma care

Physical trauma is one of the major causes of death and disability worldwide. In Sweden a similar pattern can be seen despite having a well-organised health-care system. Improvements in trauma care can increase survival for patients. Triage needs to be efficient and direct patients to adequate level of care. Patients’ experiences of received care in the acute setting are rarely reported and needs to be investigated to increase patient satisfaction.

The aim of this thesis was to investigate patient and organisational perspectives of initial trauma care.

Study I was a quasi-experimental, implementation study, evaluating a criteria-directed protocol for triage of trauma patients. The results showed that by using the protocol, over triage rate was reduced from 74% to 52%. However, under triage increased from 7 % to 10%. After a meticulous review of the medical charts of the under triaged patients, no preventable deaths in this group was detected.

In study II, individual interviews were held with16 trauma patients regarding their experiences about the initial trauma care in the trauma room. The interviews were transcribed and analysed by using content analysis. The result was presented as one main category: “feeling safe in a frightening situation” and three generic categories: “emotional response”, “physical discomfort” and “feeling prioritised or being ignored”.

To summarise, findings from the two studies showed that there is room for improvements in in-hospital triage as well as in the psycho-social treatment of trauma patients at the trauma centre.

List of scientific papers

I. A criteria-directed protocol for in-hospital triage of trauma patients. Granström A, Strömmer L, Schandl A, Östlund A. European Journal of Emergency Medicine. 2018;25(1):25-31.
https://doi.org/10.1097/MEJ.0000000000000397

II. Patient experiences of initial trauma care -an interview study at a Swedish level 1 trauma centre. Granström A, Strömmer L, Falk A-C, Schandl, A. [Accepted]
https://doi.org/10.1016/j.ienj.2018.08.003