Items tagged with ENGLISH

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.

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Introduction:
This policy describes the Trauma Service Performance Improvement and Patient Safety (PIPS) plan at Medical Center of the Rockies (MCR).

Scope:
View the UCHealth Policy Scope Statement to see where this policy applies. This policy applies to Medical Center of the Rockies.

Philosophy of the Trauma Program
The trauma program provides a coordinated multidisciplinary approach to patient management throughout the continuum of care from pre-hospital to rehabilitation. The management of multiple, complex injuries require a team of individuals with expertise in a number of areas. A coordinated team approach prevents unnecessary delay in care, missed injuries, conflicting treatment plans, inappropriate management, disability, and death. The multidisciplinary team leader is the trauma surgeon. The trauma surgeon not only contributes specific care in the area of his or her specialty, but also oversees and coordinates the care provided by the other consulted disciplines. The Trauma Medical Director (TMD) will interpret and reconcile any conflicts in the recommendations of team members and consultants.

Mission and Vision of the Trauma PIPS Program
The goal of the Trauma Performance Improvement and Patient Safety (PIPS) program is to provide a systematic framework to support the improvement of trauma patient care and outcomes through continuous monitoring, and assessment of structures and processes, followed by the implementation of an action plan when an opportunity for improvement is identified. The results of changes are then followed by reassessment to ensure loop closure.

The Trauma Service is committed to providing measurable, high quality, cost-effective health care through active involvement of all medical and hospital staff.

Purpose and Objectives:

• To integrate and coordinate all trauma performance improvement activities throughout the hospital.
• To identify and resolve interdisciplinary process problems, prevent duplication of efforts and facilitate communication.
• To utilize continuous quality improvement concepts/techniques to improve selected processes and systems.
• To utilize external reference databases to monitor performance and to assist in setting priorities for improving performance.
• To shift the primary focus from the performance of individuals to the performance of the trauma system’s processes and systems, while continuing to recognize the importance of the individual competence of all team members.
• To maintain current written standards of professional practice and related policies and procedures that demonstrate compliance with both internally and externally established standards and regulations.
• To integrate the standards from the Colorado Statewide Trauma Care Systems Act, the American College of Surgeons’ Committee on Trauma, and the Joint Commission.

Issue identification

• Trauma patient’s length-of-stay in ED was 90 minutes. Delayed transfer due to radiological studies performed before transfer.

Specific goal & measure of achievement

• Trauma patient requires transfer out of ED within 60 minutes
• Ninety percent of the time

Analysis w/data (when available)

• Eight of 15 cases (53%) met 60-minute standard

Develop and implement action plan

• Send case to peer review; review trauma transfer protocol, discuss rationale for refraining from obtaining studies that do not impact the resuscitation, etc

Evaluation, re-evaluation, re-re-evaluation

• Trend, measure performance and strategize solutions
• Six months later 10 out of 12 new cases (83%) met 60- minute standard. >>> New action plan, continue to trend and measure performance

Loop closure

• Goal attained; action(s) resulted in goal attainment
• Eight months later 12 of 13 cases (92%) met the goal.
• Once goal is attained, can close the loop or continue to trend to verify continued success.

Why PIPS?

• Evaluates
  • patient care outcome
  • provider response
  • system performance
• Improves patient care at bedside level
• Fosters competent and current providers
• Evaluates the cost of care
• Enhance the fiscal aspect of a surgical program

ACS-COT requirements

• “Demonstrate a continuous process of monitoring, assessment, and management directed at improving care”
• “This effort should routinely reduce unnecessary variation in care and prevent adverse effects”
• “the PIPS program must be supported by a reliable method of data collection that consistently obtains the information necessary to identify opportunities for improvement” CD 15 3 (I IV)

The Victorian State Trauma System provides support and retrieval services for critically injured patients requiring definitive care, transfer and management. This abdominal trauma guideline provides evidence based advice on the initial management and transfer of major trauma patients who present to Victorian health services with severe abdominal injuries.

This abdominal trauma guideline is developed for all clinical staff involved in the care of trauma patients in Victoria. It is intended for use by frontline clinical staff that provide early care for major trauma patients; those working outside a Major Trauma Service (MTS) and those working directly at a Major Trauma Service (MTS).

The guideline has been assessed utilising the AGREEII methodology for guideline development and is under the auspice of the Victorian State Trauma Committee (VSTC).

• Management of abdominal trauma largely depends upon the haemodynamic stability of the patient.
• Blunt and penetrating abdominal trauma have different care pathways.
• Widespread availability of CT scanning has seen a shift in the management of haemodynamically stable blunt abdominal trauma patients towards non-operative management.
• Delay in diagnosis and treatment of hollow viscus injury leads to early peritonitis, haemodynamic instability and increased mortality and morbidity.
• Consultation with ARV for advice and transfer to a MTS should be initiated for all penetrating abdominal trauma and in significant blunt trauma.

Introduction

Abdominal trauma accounts for 22% of body regions injured in major trauma and can be difficult to diagnose and manage.2 A high index of suspicion should be maintained for any multi-trauma patient, particularly where the mechanism of injury may suggest significant abdominal injury. Understanding the types of injuries is important for the planning and organisation of trauma services. Penetrating injuries are frequently isolated injuries, but may cause severe organ or vessel disruption and rapid bleeding. Securing breathing and control of bleeding are often the priorities with this type of injury.

The vast majority (over 90%) of major trauma in Australia is caused by blunt injury mechanisms, such as those caused by motor vehicle collisions (MVC), falls, and being forcefully struck. Blunt injuries less often present with rapid exsanguination, but are more often associated with multiple organ failure, combinations of airway, breathing, circulatory, neurological and musculoskeletal deficiencies, and permanent physical and cognitive disabilities among survivors.

Missed abdominal injuries are a major cause of avoidable death in trauma patients.3 The principles of initial management focus on the detection of any injury and determining the need for urgent intervention. Investigations such as the Focused Assessment of Sonography in Trauma (FAST) and Computerised Tomography (CT) scanning can determine the presence of injuries in combination with assessment.