Barriers to and facilitators of a screening procedure for PTSD risk in a level I trauma center.

McBain SA, Sexton KW, Palmer BE, Landes SJ. Barriers to and facilitators of a screening procedure for PTSD risk in a level I trauma center. Trauma surgery & acute care open. 2019 Aug 12; 4(1):e000345.

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Abstract:

Background: Patients admitted to the hospital after an injury are at a greater risk for developing post-traumatic stress disorder (PTSD) due to the nature of the injury and the traumatic nature of necessary medical interventions. Many level I trauma centers have yet to implement screening protocols for PTSD risk. The goal of the study was to characterize the barriers to and facilitators of implementation of a screening procedure for PTSD risk in a level I trauma center. Methods: We conducted semistructured qualitative interviews with multidisciplinary academic medical center stakeholders (N = 8) including those with clinical, research, teaching, and administrative roles within an urban academic medical center's Department of Surgery, Division of Acute Care Surgery. We analyzed the qualitative data using summative template analysis to abstract data related to participants' opinions about implementation of a screener for PTSD. Results: Participants' general perception of screening for PTSD risk after injury was positive. Identified challenges to implementation included timing of screening, time burden, care coordination, addressing patients with traumatic brain injury or an altered mental status, and ensuring appropriate care after screening. Reported facilitators included existing psychosocial screening tools and protocols that would support inclusion of a PTSD screener, a patient-centered culture that would facilitate buy-in from providers, a guideline-driven culture, and a commitment to continuity of care. Conclusions: This study offers concrete preliminary information on barriers to and facilitators of PTSD screening that can be used to inform planning of implementation efforts within a trauma center. Level of evidence: Level V, qualitative.