The lost to trauma patient follow-up: A system or patient problem

BACKGROUND: The objective of this study was to explore the reasons for trauma patients' failure to follow up at a trauma clinic (TC). METHODS: A 1-year retrospective analysis was conducted on those trauma services patients (n = 799) who were discharged from Parkview Hospital in 2009. Hospital electronic medical records were examined to identify variables of interest; telephone interviews were attempted on those patients who failed to follow up (FTF); and calls were made to the offices of involved subspecialist (SS) to determine if any follow-up had occurred. Data analysis was performed by Microsoft Excel and SPSS. RESULTS: Two hundred thirty-three patients were identified as having FTF in the TC. Patient or external factors caused a follow-up loss for 147 patients (63.1%), and 44% of them did have a follow-up with an SS. Hospital or internal factors resulted in 86 patients (36.9%) being FTF, and 43% of them were seen by an SS. The physician compliance rate per policy was 89.2% (713 of 799). The patient compliance rate at TC follow-up was 79.3% (566 of 713). The total patient compliance rate both at the TC and SS follow-up was 87.2% (669 of 767). No significant demographic differences in age, sex, Injury Severity Scores, hospital payment status, or distance from the hospital were noted between those patients who had FTF in the external or internal factor groups. Of the 130 patients who had no follow-up, 39% did meet follow-up criteria. CONCLUSION: Only 10.8% of the trauma patients who had appointments for any posttrauma follow-up had FTF, implying that the patient is not the reason for FTF but that FTF is a system issue. With improved patient education on the day of hospital discharge and improved physician discharge orders, trauma patient follow-up could approach 100%. (J Trauma Acute Care Surg. 2012;73: 1507-1511. Copyright (C) 2012 by Lippincott Williams & Wilkins) LEVEL OF EVIDENCE: Epidemiologic study, level III.