Outcomes of a physiotherapy performed trauma tertiary survey role on a dedicated trauma ward in a Level 1 trauma service.

Abstract

The Trauma Tertiary Survey (TTS) is considered a key strategy for identifying injuries overlooked during the initial trauma resuscitation and assessment. Traditionally performed by medical staff, TTS completion is resource intensive, and the standard of performance may vary due to inconsistent training and level of trauma experience. Trauma physiotherapists may provide an alternative model to improve timeliness and quality of TTS performance. A pre-post intervention study was conducted on the trauma ward of an Australian Level 1 trauma centre. During the baseline phase (October 2022-March 2023), TTS were performed by junior medical staff. During the intervention phase (May 2023-April 2024), TTS were additionally delivered by senior trauma physiotherapists with extensive trauma experience and specialised training. Implementation was supported by a formal competency framework, training schedule and governance structure. Outcomes included TTS timeliness, injury detection rates, and safety. Of 1147 eligible patients during the 12 month intervention phase (vs 591 in 6 month baseline), physiotherapists performed 825 TTS (72%). Median time to TTS improved from 41 to 27 h, rates of TTS on day of discharge decreased from 12.3% to 4.8%. Physiotherapists identified 120 injuries on their TTS, predominantly musculoskeletal and soft tissue. Physiotherapy performed TTS significantly improved timeliness and efficiency of TTS completion without compromising safety or quality. This shared care model supports workload demand, timely injury detection and patient care in busy trauma services.