Sentinel Events During the Transition From Hospital to Home: A Longitudinal Study of Women With Traumatic Brain Injury
Authors: Emily Nalder, Jennifer Fleming, Petrea Cornwell, Michele Foster, Elizabeth Skidmore, Carolina Bottari, Deirdre R. Dawson
Objective: To describe the occurrence of sentinel events and their influence on community integration of women with traumatic brain injury (TBI) transitioning from hospital to home.
Design: A longitudinal study was completed with data collected before and at 1, 3, and 6 months after
Setting: Brain injury rehabilitation unit and acute neuroscience ward.
Participants: Women (NZ25) with severe TBI (aged between 17 and 50 years; duration of posttraumatic amnesia ranged from 1 to 123d). Sixteen family caregivers also participated.
Interventions: Not applicable.
Main Outcome Measures: Community integration was measured using the Mayo-Portland Adaptability Inventory. Depression, anxiety, and stress were measured using the Depression Anxiety Stress Scale. The Sentinel Events Questionnaire was used to record life events that potentially influence the transition process.
Results: Most women (>16 at each time point) experienced mild to moderate impairments in psychosocial integration. A third of the sample reported symptoms of depression (nZ8), anxiety (nZ9), and stress (nZ7) that exceeded clinical cutoff levels on at least 1 occasion. At 6 months, 3 women reported clinically significant depression and anxiety (12%) and 2 reported significant stress levels (8%). Positive sentinel events such as return to meaningful occupation were common (nZ14). Negative sentinel events were also quite common. For example, reduced access to
therapy, reported by 10 women, was associated with poorer participation levels.
Conclusions: These findings suggest that the presence of sentinel events influences the transition experiences of women with TBI in this sample. Rehabilitation should consider the occurrence and impact of sentinel events because this may facilitate successful transitions.