Items tagged with 2019

Background: In majority of the low- and middle-income countries (LMICs), the societal cost of injuries are alarming. The severity and magnitude of the road traffic injuries (RTI) in India are not estimated accurately due to the lack of availability of data. The data are limited on the aspects such as demographics, cause, severity of injury, processes of care, and the final outcome of injuries. This study aimed to determine the feasibility of setting up a sustainable trauma registry in Odisha, India, and to determine the demographics, mechanism, severity, and outcomes of injury reported to the facilities/hospital.

Materials and Methods: A prospective observational study was conducted at Srirama Chandra Bhanja Medical College and Hospital (SCB-MCH), Cuttack, India. Injured patients who reported/admitted to the emergency department were observed, and data were collected by using a minimum data set (MDS) developed by the World Health Organization (WHO). Data were collected for a period of one month in June 2015. Observations were collected on 20 variables. The completeness of data collection ranged from 60% (19 variables) to 70% (23 variables) out of total 33 variables.

Results: This study uses 145 cases of injury reported in SCB-MCH. Out of the total reported population at the trauma registry, about 21% were females. Nearly 45% of the injury occurred on road/street. RTI accounted for 36.6% of injury. Out of the total admitted cases, 2.8% died in the emergency department, 11% were discharged to home, and 7.6% left against medical advice. Majority of the respondents have reported single injuries (77%). Head injuries were more common and severe among majority of the reported cases (44.1%), followed by neck injury (28.3%) and chest (15.9%).

Conclusions: This study indicates the challenges in obtaining complete data on injury. Data were missing in terms of admission, discharge, and Glasgow Comma Scale (GCS) among the studied population. This study suggests that individual GCS scoring should be done instead of total GCS scoring in each trauma patient. By collection and storage of adequate data, better policy decisions can be implemented, which will minimize and prevent trauma cases and maximize the utilization of the available resources.

Notification Routines
From the scene of the accident, reports are made to the Emergency Medical Communication Center (AMK) and to the coordinator in the Emergency Department in accordance with specified criteria. The coordinator notifies the trauma team through a group search with key words on the calling display. The team members acknowledge via the calling. In the case of early warning, the team leader, who is responsible for communicating, among other things, to the chief anesthesiologist (862) / coordinator for intensive care units (581-73600) and to the interventional radiographer / radiologist / operating nurse, is informed about the use of Trauma-OP.

Graded Trauma Alarm
If physiology is affected, a large trauma team (Stort Team, ST) is called. In the case of serious injury without affected physiology, and accidents with high energy, but physiologically normal patients, a limited team (Lite Team, LT) is called. If the patient assigned to the Lite Team turns out to be more seriously injured or additional resources are needed, additional resources are called in. Personnel resources are graduated as early as possible after the primary survey. Both 833 and 832 should be present if the patient is critically ill. However, the vast majority of patients are not physiologically affected and must be handled by either 833 or 832 (by agreement between them), together with another LIS (829, 830, 831), who has passed the ATLS, as examining surgeon. This ensures a broadening of expertise, as well as flexibility, which means that other emergency operations are affected as little as possible. Transfer of a physiologically stable patient with presumed isolated head injury from another hospital is accepted by 833 or the one 833 delegates the task to, together with on-call neurosurgery (which fills in the trauma record and writes the income record). Patients who do not meet the criteria for admission to a trauma team can be seen by a surgeon in reception (832 or 833), and a trauma alarm can be triggered if necessary. For anaesthesia, separate individual assessments are made of whether to provide 2 nurses and/or doctors.

Patient handover from the Emergency Department (ED) nurse to the Southern Intensive Care Unit (ICU) nurse

The ED and ICU have been looking at ideas to improve the patient handover process and satisfaction between nursing staff. Patient handover from one unit to another represents a vulnerable time for communication of patient information. Both areas are fast-paced, unpredictable and clinical information can be lost during the patient handover process. The plan is to standardise the handover process, similar to the current process for cardiac surgery patients returning to the ICU, and use a handover tool.

The future plan for ED to ICU patient handover:

1. Clear identification of the ICU primary nurse to the ED nurse.
   The patient’s primary nurse should identify themselves to the ED nurse. When ICU staff wear plastic aprons it can be difficult to see names badges and identify who’s who. Ideally at the handover time if the patient’s condition allows the ICU primary nurse should not be task focused and therefore be in a position to clearly listen to the handover.
2. Handover PRIOR to transfer to the ICU bed (pitstop).
   We all know when a patients hits the ICU bed, it’s hard to stop the urge of ‘doing’ rather than ‘listening’ and ‘doing’ can be distracting for other team members to listen to a handover. Unless the patient’s condition requires urgent transfer to the ICU bed for immediate intervention an effective way of ensuring that everyone listens to the handover is to stop the ED stretcher next to the ICU bed and deliver handover PRIOR to transfer. In this way A. everyone listens, and B. everyone has a shared mental model from the outset, before individual task fixation occurs.
   
   The decision about handover prior to transfer verse immediate transfer is best made by the handing over team as they will know the patients condition.
3. Handover.
   The ISBAR form is currently used throughout the SDHB and we have made adjustments to it for ICU patients. It provides a structured framework for the ED nurse to write on and assists as an aide memoir. When information is handed over each time in a similar way it can reduce variability and important information is not forgotten.

We hope the use of the pitstop style handover and use of the ISBAR form will assist to improve the quality of patient handover and staff satisfaction, reduce variability, potential loss of information and result in improved quality of care and ultimately patient safety. Future feedback on the form and handover process will be sought for ongoing development.

No abstract available.

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These guidelines outlines the process of the completing the tertiary survey on trauma inpatients and who, how and when this should be completed.

Definitions

Tertiary Survey refers to the comprehensive general physical re-examination and review of all investigations, including diagnostic imaging and blood results, within 24 hrs and again when the patient is conscious and cooperative (Hajibandeh et al, 2015)

Missed injury detection are those that are not identified by primary or secondary surveys but are detected by tertiary survey (Hajibandeh et al, 2015).

Overview/Background

Missed injuries are considered an important issue in trauma patients and can lead to significant mortality and morbidity. The reported incidence of missed injuries is variable ranging from 1% to 40%. Risk factors for missed injuries include:

Altered level of consciousness such as:

• Central nervous system injury
• Intoxication and sedation
• A distracting injury
• Poly trauma patients
• Patients needing emergency surgery

The tertiary survey is widely used in the reassessment of trauma patients, reducing any missed injuries that may be overlooked at the initial time of presentation. The best available evidence demonstrates support in favour of tertiary survey in terms of missed injury reduction, and supports its use in management of trauma patients (Hajibandeh et al, 2015).