Patient's experience leads to new alert system to improve hospital visits for people with PTSS

Experiencing a medical trauma can have a deep-seated effect on many patients, making a return visit to hospital an anxious time for them – even years later.

Up to 20% of people who have been seriously ill develop Post-Traumatic Stress Symptoms (PTSS). It can affect how they react to the hospital experience, to staff, and to medical treatments for months or years later.

Now, however, a new alert system is helping clinicians be better prepared to treat patients with this anxiety disorder.

The new system has been introduced to the Welsh Clinical Portal (WCP) – a secure NHS Wales digital site used by clinical staff - to flag the patient’s circumstances and any triggers they may have.

Medics can then give additional support during a situation that could trigger symptoms.

Clare Baker, Deputy Head of Quality and Safety, said: “PTS Symptoms are caused by stressful, frightening or distressing events which can happen anywhere, including in hospital settings.

“Symptoms are often involuntary and vivid as the person can relieve the traumatic event in the form of flashbacks, or nightmares.

“It can have a significant impact on daily life and can affect how people react to the hospital experience, staff and medical treatments.

“PTS symptoms can be triggered in medical settings even if the original traumatic experience wasn’t medical. Triggers can include being touched, feeling helpless or out of control, smells, sounds or visual cues.”

The alert system now available to clinicians comes after a patient agreed to share her experiences of PTSS during an acute hospital admission and subsequent outpatient visits.

The lady had injured ligaments in her foot, but her PTSS resulting from her previous admission meant she put off seeking medical assistance for seven hours. When the pain became too much, a relative telephoned ED before she arrived to inform them of her PTSS. As a result, after being triaged, medics told her to wait in the car because it made her feel less anxious than waiting within the emergency department, and she was telephoned when her appointment arrived.

She described the way medics treated her sympathetically, respectfully and gave her continuous reassurance, going to lengths to make extended explanations and demonstrations of everything they were doing – even why they were opening a window, and listening intently to her needs.

The patient received similar treatment from a subsequent visit to a consultant after he was informed about her PTSS, but she contrasted it with a third visit, as well as one to receive advice about physiotherapy, when staff were not aware of her PTSS.

On those occasions, when the clinicians treating her were unaware of her disorder and hadn’t taken the extra time to explain procedures to her, she described her anxiety at their interaction, triggering traumatic memories and made her experience a flashback. This turned the previous ‘positive’ appointments into ‘negative’ ones.  

Her experiences contributed to the introduction of the alert system on the WCP to inform the clinician of the patient situation and the trauma triggers.

Clare Baker added: “Clinicians always listen to the needs of the patient, but they may not be aware of triggers in someone with PTSS, and could therefore inadvertently make their hospital experience an anxious one.

“Working with Elizabeth Brimacombe and Alison Gorman we put the process into place following this patient’s experience to identify PTSS on patient’s records with the patients consent’.

“This alerts the Health Care Professional, enabling them to put support mechanisms in place for the patient.

“It is a simple system but one which could make a huge difference to a patient, and we want their hospital experience to be a positive one.”

The alert system has since been used on a subsequent health visit by the patient whose experienced inspired it. The medical professional was directed to the alert and advice on the system so they were made aware of her PTSS and support mechanisms that help her.