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Open Access

Trauma Transitional Care Coordination: protecting the most vulnerable trauma patients from hospital readmission

Erin C Hall, Rebecca Tyrrell, Thomas M Scalea, Deborah M Stein
DOI: 10.1136/tsaco-2017-000149 Published 8 February 2018
Erin C Hall
1Department of Surgery, Division of Trauma, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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Rebecca Tyrrell
2R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Thomas M Scalea
2R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Deborah M Stein
2R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Article Figures & Data

Tables

  • Table 1

    Identified risk factors for readmission

    Social factorsAny previous readmission
    Lack of home assistance/care services
    Poor or absent insurance
    Medical historyPsychiatric disease
    Drug abuse
    Multiple comorbidities without primary care
    Trauma sequelaePulmonary embolism without primary care
    Vascular injury without primary care
    New tracheostomy
    New traumatic brain injury
    High-output fistula
    Large, open wounds before definitive closure
  • Table 2

    Timeline for Trauma Transitional Care Coordination interventions TTCC

    Before discharge
    Identification of high-risk patient
    Initial meeting with TTCC coordinator
    Within 72 hours of discharge
    Call to patient or caregiver
    Identification of barriers to care
    Complete medication reconciliation
    Ongoing
    Coordination of medical care/appointments
    Personalized problem solving
    • TTCC, Trauma Transitional Care Coordination.

  • Table 3

    Causes of 30-day readmissions among Trauma Transitional Care Coordination enrollees

    Non-preventableWorsening of known infections (8)
    PreventableInadequate culture follow-up (1)
    Symptomatic pleural effusion (1)
    Incorrect discharge medications (1)
    Inappropriate discharge location (5)
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Trauma Transitional Care Coordination: protecting the most vulnerable trauma patients from hospital readmission
Erin C Hall, Rebecca Tyrrell, Thomas M Scalea, Deborah M Stein
Trauma Surg Acute Care Open Feb 2018, 3 (1) e000149; DOI: 10.1136/tsaco-2017-000149

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Trauma Transitional Care Coordination: protecting the most vulnerable trauma patients from hospital readmission
Erin C Hall, Rebecca Tyrrell, Thomas M Scalea, Deborah M Stein
Trauma Surg Acute Care Open Feb 2018, 3 (1) e000149; DOI: 10.1136/tsaco-2017-000149
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Trauma Transitional Care Coordination: protecting the most vulnerable trauma patients from hospital readmission
Erin C Hall, Rebecca Tyrrell, Thomas M Scalea, Deborah M Stein
Trauma Surgery & Acute Care Open Feb 2018, 3 (1) e000149; DOI: 10.1136/tsaco-2017-000149
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