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Improving patient outcomes by seeing and treating trauma as a public health priority

A doctor and a patient
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The Trauma Quality of Life Clinic takes a holistic approach to firearm injury to promote healing and resilience.

Surgeon General Dr. Vivek Murthy has issued a first-of-its-kind advisory declaring gun violence a national public health crisis and recommending it be treated as such.

Colleen Trevino is a nurse practitioner at Froedtert & the Medical Collegeand the director of the Trauma Quality of Life Clinic. She has treated trauma patients for over 20 years, many of them for firearm injuries. The clinic is the only program nationwide that takes a holistic approach to firearm injury to promote healing and resilience in the aftermath of such traumatic events. Trevino will be a speaker at UW-Milwaukee’s upcoming Trauma in Our Community Conference.

Typically when a patient arrives to get immediate medical treatment due to a firearm injury, a trauma team is alerted and begin accessing the patient's most pressing needs. Once those determinations are made, the patient receives the medical attention they require until they are physically healed enough to be discharged. However, Trevino notes many challenges still remain for patients after they're cleared to go home.

Long term support is not a new idea, and Trevino notes they take lessons learned from cancer or neurology care models and apply it to "the disease of trauma." For the trauma team at Froedtert, this means starting to offer and explain support systems to the patient from the beginning.

"We are really fortunate to have a trauma psychology program here. So, we screen everybody for depression, anxiety and post traumatic stress disorder," explains Trevino. "If they screen high, they are actually seen by our trauma psychologists. Once they go home, we send them home with all the directions on how to care for their wounds and how to take their medicines, but as you can imagine it's extremely overwhelming."

In order to better identify resources that patients need at home, practitioners work with 414 Life representatives in the hospital. "Their focus is to prevent the cycle of violence ... and what they also do for us is provide a credible messenger. So they are really able to connect us with our patients and provide a bridge of trust," Trevino explains.

In order to continue to better serve trauma patients, the Trauma Quality of Life Clinic began in November of 2020 to ensure that providers were addressing all the biopsychosocial needs of patients. This clinic that emphasizes both medical and psychological care in addition to ongoing support and resources such as trauma social workers, physical therapy, additional referrals and more.

Trevino notes they also started a nurse navigator program to serve as an additional connection point for the patients to reach out to first. "I think that has once again helped really bridge that gap between discharge and going home," she says. "We were able to drop our no-show rate to 12%, which means the majority of our patients were coming back for the resources that they needed in order to heal."

Trevino and her team have noticed a distinction in patients that experience gunshot wounds, specifically. "We do know that our patients who are injured by firearm and gun violence do have worse chronic pain, more depression, more post traumatic stress disorder or long term quality of life outcomes," she says. "And so we have verified that, indeed, they are at a higher risk for these poor quality of life outcomes."

"I'll tell you, 20 years ago I didn't ask questions about are you having nightmares, are you coming out of your house, are you feeling safe? Because I couldn't address those issues," she adds. "Now, we address all those issues and we ask all the questions."

For Trevino, thinking about and prioritizing trauma as a public health priority has taken years to develop but has enabled more impactful outcomes in the community. She says, "whether it's physical or mental, we have to be responsible for ensuring that our patients recover to the best of their ability. It's not just about this injury. It's about everything that goes along with the experience. And so, it definitely needs to be refocused into a public health model."

The Trauma in Our Community Conference — Healing Trauma as a Public Health Priority conference takes place in person and online on June 27. You can find more information here.

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Audrey is a WUWM host and producer for Lake Effect.
Rob is All Things Considered Host and Digital Producer.
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