Aims
To evaluate the feasibility and acceptability of a post-discharge Patient Navigator service for older adults following trauma, and to characterise unmet needs arising during the transition home.
Methods
A single-centre mixed-methods pilot study recruited community-dwelling adults aged ≥65 years admitted with physical trauma and discharged home. Participants received one to two telephone contacts per week for four weeks. Feasibility outcomes included recruitment uptake, retention, adherence to scheduled contacts, and intervention fidelity. Navigator clinical notes and post-intervention interviews were analysed descriptively to identify unmet needs, navigator actions and participant perceptions. Quality of life (Assessment of Quality of Life-8D) and function (Barthel Index) were collected, describing recovery.
Results
Thirty of forty-five (67%) eligible patients were consented and 29 (97%) completed the intervention. Overall, 76% of scheduled calls were completed. Participants commonly required clarification of discharge information, guidance regarding recovery progression and symptom monitoring advice. Navigator actions included information reinforcement, sense-making of care plans and safety-netting advice. Participants described reassurance, confidence-building, and valuing access to a clinically trained professional during early recovery. Unplanned health service use, including general practitioner visits and emergency department presentations, occurred during follow-up.
Conclusions
A Patient Navigator service was feasible and highly acceptable. Early post-discharge contact addressed transitional vulnerabilities in older adults. Findings suggest a flexible, needs-based model, with some patients benefiting from a single structured contact and others requiring more regular support. Integration within collaborative care pathways may enhance continuity following trauma. Controlled studies are needed to determine impact on service use and longer-term outcomes.