D. Ortiz1, J. V. Barr1, J. A. Harvin1, M. K. McNutt1, L. Kao1, B. A. Cotton1 1McGovern Medical School at UTHealth,Acute Care Surgery,Houston, TX, USA
Introduction: Psychiatric illness is an independent risk factor for trauma and recidivism. Budget cuts have steadily decreased funding for public hospitals and have resulted in states closing public psychiatric inpatient beds. It is unclear if and how these trends have affected resources for trauma patients with preexisting mental illness. The purpose of this study was to gauge perceptions of needed and currently available resources for this patient population.
Methods: A 10-question survey was developed to capture the volume of psychiatric patients, available psychiatric services, and perceived need for resources. The questions were inspired by discussions with three independent psychiatrists with trauma patient practices. The survey was peer reviewed and modified by two separate trauma researchers. It was sent to 27 trauma surgery colleagues at different Level-1 trauma centers across the United States using a SurveyMonkey email link. Responses were anonymous and descriptive analyses were performed.
Results: 22 of 27 surgeons responded (81% response rate). Of the responding centers, 10 (47.6%) admitted 1-5 patients with preexisting serious mental illness weekly, while 6 (27.3%) and 5 (22.7%) admitted 6-10 and >10, respectively. One center did not respond to this question. 14 of 22 (63.6%) reported having acute situational support services available for trauma patients. Ten (45.5%) respondents did not know how many psychiatry consultants were available at their institution, while a single center had one consultant available. Six (27.3%) and 5 (22.7%) had 2-4 and 5 or more consultants, respectively. Twelve (54.6%) surgeons reported to have no designated outpatient follow-up for acute or chronic psychiatric issues for trauma patients, while 2 (9.1%) didn’t know. Sixteen (72.7%) stated that expanded psychiatric services are needed for their trauma center, while 4 (18.8%) said they didn’t know, one said no (4.55%), and one (4.55%) hasn’t thought about it. The final question allowed the respondents to choose multiple areas of perceived need for improvement in psychiatric care for the trauma patient (Table).
Conclusion: Trauma patients frequently present with preexisting serious mental illness. Over half of the surveyed surgeons reported having no outpatient follow-up for these patients, and almost three quarters perceived the need for expansion of psychiatric services. Strikingly, many respondents were unaware of the psychiatric resources available at their centers, while a few had not thought about the challenges in treating this vulnerable patient population. In addition to a lack of resources, these findings highlight an overlooked gap in high quality, patient-centered trauma care.
