Understanding experiences, contextual factors and implementation outcomes of a major trauma service: A qualitative study.

Introduction: The delivery of optimal trauma care requires an interdisciplinary team approach. However, the composition of these teams often varies across health services and systems. Moreover, different models of care exist which impact the way trauma teams operate, including consultative models and admitting models. This study aimed to explore contextual factors (e.g., barriers and facilitators) influencing trauma service model optimisation, propose strategies to address the factors, and understand implementation outcomes of the model.

Methods: Staff and patients within a large public, major trauma referral centre with statewide outreach were interviewed, and data were analysed using a hybrid qualitative inductive and deductive design. The predominantly inductive approach used interpretive description methodology to produce a narrative and themes related to the interviews. The deductive approach used the Consolidated Framework for Implementation Research (CFIR 2.0) to understanding the influence of multi-level factors on implementation, and mapped data to five implementation outcomes. Finally, strategies addressing the factors were mapped to the nine domains of Expert Recommendations for Implementing Change (ERIC) to inform future research and service redesign.

Results: Twelve staff and six patient interviews were conducted. 'Connecting with people' was a concept that underpinned all three themes of caring for the patient as a whole person; coming together to create a cohesive team identity; and securing a place in the bigger health system. The findings suggest that the Trauma Service improved continuity and enabled patient-centred care, but its perceived effectiveness was hindered by hospital attitudes, leadership changes, staff shortages, and dependence on key individuals. Participants highlighted acceptability and sustainability as key implementation outcomes, with patients viewing the Trauma Service positively while staff had mixed opinions. Fourteen implementation strategies were identified, including restructuring the Trauma Service for continuity of care, pre-planning with stakeholders, using cohorted trauma wards and advocating for funding to ensure sustainability.

Conclusions: The themes highlighted that optimal trauma care delivery is focussed on connecting with people; recognising and caring for the trauma patient as a whole person; and knowing individual and collective strengths. The findings may have implications for designing or redesigning similar trauma services in the future by ensuring external and internal risks to service provision are mitigated.