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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.

PURPOSE
The Trauma Program Performance Improvement (PI) Plan is designed to ensure efficient, cost effective, high quality patient care that is facilitated by continuous, systematic and objective data analysis and multidisciplinary peer review to identify opportunities to improve patient safety through all phases of trauma care. The ultimate goal is to reduce mortality and morbidity in the Trauma patient population. The plan is to provide specialized, effective care to all injured patients presenting to this facility.

No abstract available.

1976 was a key year in the evolution of care of the injured patient. In that year, Dr. Donald Trunkey and the American College of Surgeons Committee on Trauma (ACS COT) laid out the first list of criteria to define the essential elements of a trauma center. This simple optimal resources document led directly to the development of the ACS COT’s Verification Review and Consultation (VRC) program, which has grown to 510 verified trauma centers across the United States. The same year, orthopaedic surgeon Dr. James Styner and his family were tragically injured in a plane crash in a rural Nebraska cornfield. The lack of trained personnel and resources available to care for his family compelled Dr. Steiner and his colleague, Dr. Paul “Skip” Collicott, to develop “Advanced Trauma Life Support (ATLS)”, with the goal of ensuring that surgeons providing injury care would know what to do when confronted with an injured patient. ATLS was quickly adopted and aggressively promulgated by the ACS COT, and has grown to become a global movement. The first course was held in 1980, and since that time ATLS has been diligently refined and improved year after year, decade after decade, with more than a million students taught world-wide.

These two programs, the VRC and ATLS have transformed the care of injured patients across the globe, resulting in hundreds of thousands of lives saved. Although ATLS was intended as an educational program, and the VRC was intended to be a set of standards, ATLS has standardized the care of trauma patients and the VRC educated the trauma community in the US on how best to provide optimal care for trauma patients. Now 60% of ATLS classes are held outside of the US, taught by local faculty based on the same central principles. By contrast, the concept of trauma center verification established by the VRC as not been established outside of the US.

Ultimately, reducing injury death and disability at a public health level requires a multifaceted, integrated approach, one that includes prevention, prehospital care, a network of definitive care facilities, and resources for rehabilitation. While training providers in injury care is an essential step, trained providers have limited impact without the other essential elements of a trauma system, especially a network of capable trauma centers. The development of a trauma system cannot be driven by ATLS education alone; an organized trauma center verification program, such as the VRC, is equally critical.

In 2015, Dr. Maria Fernanda Jimenez, the Chair of the International Injury Care Committee (I2C2), reached out to the ACS COT asking to move forward with a translation of the current Optimal Resources for Care of the Injured Patient 2014. This initial aim of translating the document led to a discussion involving the ACS COT Executive Committee, the Trauma Systems Evaluation and Planning Committee (Robert Winchell) and the Verification, Review and Consultation Committee (Rosemary Kozar) to discuss the strategy and goals of the project. Following these discussions and with the unanimous support of the ACS COT Executive Committee, a pilot program in Region 14 (Latin America and the Caribbean) moved forward with three primary goals: 1) translate the Optimal Resources document to Spanish and Portugese; 2) use the translated document as a framework to establish a verification system relevant to Latin American and the Caribbean; and 3) pilot a verification process and structure in the Region. It was recognized that the Optimal Resources for Care of the Injured Patient 2014 standards could be literally translated; however, the processes and requirements would not be directly applicable to another country or region outside the US due to a wide variety of cultural and societal differences (e.g. laws, professional certifications, culture, and specific resource availability). Although the ACS COT Executive Committee and the leadership of Region 14 recognized not all the specific criteria would be directly relevant or applicable to the Region, Dr. Jimenez and the surgeons in I2C2 and Region 14 committed to a trauma center/system verification process modeled on exactly the same principles established in the United States: 1) setting relevant, high standards which elevate care; 2) ensuring the right resources, structure, processes and leadership are present; 3) using clinical data (ideally risk adjusted) for performance Improvement and outcome assessment; and 4) verifying that the standards are being met by an independent, rigorous and objective external review by clinical experts.

Trauma Center History
Trauma Care has evolved into a specialty in many local and regional hospitals over recent years. Historically called emergency rooms, trauma centers have established high quality, comprehensive medical services for patients. The public relies on trauma centers to provide quality care from the initial injury to final disposition, whether at the local hospital or tertiary care center. 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 Coordinator (TC), or a Trauma Program Manager (TPM) 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 quality improvement 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 TC or TPM. 

Trauma Center Levels
The designation of trauma levels is important to distinguish what essential services are offered at a hospital. The Minnesota Department of Health (MDH) is responsible for the designation, or re-designation, of your hospital on a three year cycle. Recommendations are given by the American College of Surgeons’ Committee on Trauma to ensure consistent practice standards and available resources. Basic definitions of each trauma level are outlined below. 

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.

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