Items tagged with 2016

Philosophy of the Trauma Program

1. Geisigner Health System is an integrated health services organization widely recognized for its innovative use of the electronic health record and the development of innovative care delivery models such as Proven Health Navigator and ProvenCare®, Acute/Chronic Programs. As one of the nation’s largest health service organizations, Geisinger serves more than three million residents throughout 45 counties in central, south-central, and northeast Pennsylvania, and also in New Jersey with the addition of AtlantiCare, a National Malcolm Balridge Award recipient. The physician-led system is comprised of approximately 30,000 employees, including nearly 16,000 physicians, 12 hospital campuses, two research centers, and a 510,000-member health plan, all of which leverage an estimated $8.9 billion positive impact on the Pennsylvania economy. Geisinger has repeatedly garnered national accolades for integration, quality, and service. In addition to fulfilling its patient care mission, Geisinger has a long-standing commitment to medical education, research, and community service.
2. Geisinger Health System has had a long tradition in the provision of trauma care and has been recognized as a regional resource trauma center since 1986. Geisinger Health System and the Janet Weis Children’s Hospital are committed to the provision of adult and pediatric trauma care which fostered them to gain accreditation as a Level One Trauma Center with Additional Qualifications in Pediatric Trauma in 1996. The Janet Weis Children’s Hospital has been accredited as a Level Two Trauma Center since 2011. To accomplish these goals, Geisinger requires strong leadership with authority to coordinate the multidisciplinary team. The need to coordinate prevention programs and to direct research activities among many different specialties providing care to the trauma patient will impact the future direction of adult and pediatric trauma care in the country.
3. Geisinger Health System has and continues to be successful in its attention to traumatized patients by providing coordinated care throughout Geisinger departments and divisions. Geisinger Health System complies with the Pennsylvania Trauma Systems Foundation (PTSF) standards for Trauma Center Accreditation and is designated as a Level I Regional Resource Trauma Center by the Pennsylvania Trauma Systems Foundation. In 2012, Geisinger Health System became part of the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP). By utilizing ACS TQIP, Geisinger Health System is elevating the quality of care currently being delivered by members of the multidisciplinary team through the use of risk adjusted benchmarking based upon national comparisons. ACS TQIP also provides education and training to help Geisinger Health System trauma program to improve the quality of data and accurately interpret our benchmark reports.
4. The Division of Trauma Surgery falls under the Division of General Surgery. The expansion of our services includes not only adult and pediatric trauma, but emergency general surgery and surgical critical care. This service will permit enhanced patient services and facilitate a robust learning environment for residents and medical students.

Introduction

About 10% of the population is injured annually, and 100,000 are injured so seriously that they need treatment in hospital. Annually, 2,500 mostly young and previously healthy people die from injuries. Injuries are the most frequent cause of death in the population under the age of 35-40. The quality of the treatment of serious injuries matters a lot for the outcome in terms of survival and sequelae. The treatment will most often be time-critical, and depends on immediately available and well-prepared expertise. A trauma system is an organization of all resources in the chain that treats the seriously injured patient, where seamless overlapping and information flow is sought in a system without thresholds or bottlenecks. The trauma system therefore encompasses all stages, from prevention to first aid at the scene of the injury to rehabilitation, it includes patient experiences and the implementation of monitoring systems such as the national trauma register.

In 2007, the specialist directors of the regional health undertakings adopted the document "Organisation of the treatment of seriously injured patients - Trauma system". The document was prepared by a group set up by the regional health organizations in 2005, with broad representation from various professional environments. In the document, CEO wrote. Bente Mikkelsen, Helse Sør-East RHF, on behalf of the four regional health undertakings that "The document will be used as the basis for a joint presentation of the case which can possibly be supplemented with necessary additions specifically for the individual regional health undertaking, before it is submitted for board consideration in all the regional the health institutions. The goal is to achieve as great a degree of coordination of the trauma systems as possible."

It still took years before decisions were made in the four RHFs, and the implementation was less coordinated than originally hoped. One of the points in the plan was the creation of a competence center for traumatology. In the work, a number of areas have been identified where it is necessary to prepare proposals for national standards. There is also a need for a body that will be a driving force in practically related trauma research. Therefore, the group believes that a national competence center must be established which, in collaboration with others, will work on the following tasks:

• Guiding standards for how the AMK staff should guide in connection with calls regarding injured patients.
• Develop uniform, national guidelines for the correct requisition of air ambulances for use in all AMK centres.
• Develop national guidelines for trauma care for ambulance services.
• Requirements for documentation of pre-hospital findings and establishment of a standard ambulance record.
• Criteria for activation of trauma teams.
• Criteria for transfer from acute hospital to trauma center (indicative, agreed regionally).
• Criteria for transfer to departments with a national function.
• Guidelines for Content in Transmission Services.
• Education.
• Trauma-related research and quality control.
• Coordination of international collaborative projects.
• Rehabilitation.
• Follow-up of quality assurance at the hospitals.
• On the basis of the inequalities in Norway and the fact that major challenges lie outside the largest cities, the group recommends that such a competence center be organized as a network with representatives from all regions and all levels of trauma treatment.

The National Competence Service for Traumatology (NKT-Traume) was opened on 15 May 2013. The Competence Service made quick contact with the specialist directors to offer to oversee a roll-out of the national trauma plan, and the specialist director meeting on 18 November 2013 commissioned the National Competence Service for Traumatology (NKT-Traume) to lead a revision of "Organisation of the treatment of seriously injured patients - Trauma system' from 2006. The mandate was drawn up after consultation with the Norwegian Directorate of Health, and was decided in March 2014, and delivery was agreed for winter 2015. The working group was appointed by the professional director's meeting following input from NKT-Traume.

Summary
Legislation enacted in 2008 enabled the Department of Health, with input from the Department of Public Safety, to develop, implement, and administer a trauma care system, including a statewide trauma registry that involves all hospitals and emergency medical services within the state.

A trauma system is an organized response to managing and improving the care of severely injured people. It spans the continuum-of-care from prevention, pre-hospital care, acute care to rehabilitation. It has been established to ensure that injured people are promptly transported to and treated at facilities appropriate to the severity of their injury. A trauma system also provides a foundation for disaster preparedness and response. As part of its day-to-day activities, a trauma system coordinates the movement and care of severely injured people.

Overview
Following legislation in 2008 and subsequent Administrative Rules adoption in 2009, every healthcare facility in South Dakota has been designated as a Trauma Hospital; thirty-one presentations have overviewed the development and vision of the trauma system; every ambulance service has completed a trauma transportation plan; and, standards including Trauma Alert Patient and Trauma Team Activation criteria have been implemented. A state trauma website has been developed and a state trauma registry has been implemented to capture data meeting inclusion criteria for subsequent analysis.

The successful efforts of many have ensured trauma care in South Dakota meets state and national standards for the safety and care of the injured patient. Through ongoing development and performance improvement, the state Trauma System will continually advance as healthcare facilities further mature and improve upon individual trauma systems.

Introduction
Welcome to the trauma and emergency healthcare system in Southwest Texas and thank you for your interest in learning more about the trauma program in Southwest Texas. You will find this manual beneficial as you embark upon this role and we encourage you to retain a copy of this text as it may serve as reference material later in your career.

Trauma Care History in Texas
Trauma care has evolved into a specialty of many local and regional hospitals over recent decades. Trauma centers have established high quality, comprehensive medical services to patients. The public relies on trauma centers to provide emergency services in settings ranging from high density urban areas to distant rural critical access facilities. Regardless of where your program is located, it provides critical services in a timely manner to patients who often need lifesaving measures. As a Trauma Program Manager or Coordinator (TPM/C), it is your primary responsibility to ensure patients are receiving the best care possible. This is often accomplished by compilation and analysis of data, policy review, and continuous performance improvement patient safety initiatives. The following chapters will provide an overview of many aspects of trauma care and acts as a guide to help you succeed in your new role as a TPM/C.

Background: Trauma information systems are needed to improve decision making and to identify potential areas of intervention.

Objective: To describe the first year of experience with a trauma registry in two referral centers in southwest Colombia.

Methods: The study was performed in two referral centers in Cali. Patients with traumatic injuries seen between January 1 and December 31, 2012, were included. The collected information included demographics, mechanism of trauma, injury severity score (ISS), and mortality. A descriptive analysis was carried out.

Results: A total of 17,431 patients were registered, of which 67.8% were male with an average age of 30 (±20) years. Workplace injuries were the cause of emergency consultations in 28.2% of cases, and falls were the most common mechanism of trauma (37.3%). Patients with an ISS ≥15 were mostly found in the 18-35-year age range (6.4%). Most patients who suffered a gunshot wound presented an ISS ≥15. A total of 2.5% of all patients died, whereas the mortality rate was 54% among patients with an ISS ≥15 and a gunshot wound.

Conclusion: Once the trauma registry was successfully implemented in two institutions in Cali, the primary causes of admission were identified as falls and workplace injuries. The most severely compromised patients were in the population range between 18 and 35 years of age. The highest mortality was caused by gunshot wounds.