M. K. Dalton1, N. M. Fox1, J. M. Porter1, J. P. Hazelton1 1Cooper University Hospital,Trauma Surgery,Camden, NJ, USA
Introduction: Despite the fact that most trauma centers have a regularly scheduled trauma clinic, research demonstrates that trauma patients do not consistently attend follow-up appointments and often utilize the emergency department (ED) for costly outpatient care. We hypothesized that patients who utilized trauma clinic following discharge would have decreased ED utilization.
Methods: A retrospective review of outpatient follow-up of patients admitted to the trauma service (Jan 2014-Dec2014) at an urban level 1 trauma center was conducted. Patients ≥18 at time of admission and discharged alive (n=2134) were included. Demographics, clinical characteristics and care utilization data were collected.
Results: 217 patients (10%) were evaluated in trauma clinic following discharge from the hospital. 21% of patients seen in trauma clinic visited the ED within 30d compared with 12% of those not seen in clinic (p<0.001) [Figure 1]. There were a total of 104 patients readmitted within 30d of discharge; no difference existed in the rate of hospital readmission between patients seen in clinic and those not seen in clinic (p>0.05). Stepwise logistic regression showed that clinic follow-up was not a significant predictor of decreased ED utilization (adjusted OR 1.16 [95% CI 0.78-1.72], p=0.461) and also showed that while ED use was a significant predictor of readmission (adj OR 216 [93-500], p<0.001), clinic visits were not (adj OR 0.74 [0.33-1.69], p=0.48). The five most common reasons for ED visits within 30d of discharge were: neurological complaint (n=38, 14%), Musculoskeletal pain (35, 13%), Infection (24, 9%), Unrelated illness or injury (24, 9%), and Wound care (23, 8%).
Conclusion: Outpatient follow up in the trauma clinic does not decrease ED utilization or hospital readmissions indicating that interventions aimed at improving access to a conventional outpatient clinic will not impact ED utilization rates. Further study is necessary to determine the best system for providing clinically appropriate and cost-effective outpatient follow-up for trauma patients.
