trauma site visits

©2011 MFMER | slide-1

Trauma Site Visits

Wayne Street RN

Meeting Name HereAnd Date Here

City – Location Identity


Objectives

• Level III and Level VI trauma site visit

• The pre-meeting conference

• Facility Commitment

• The Tour

• PI and Chart review

Type the footnote/source in this space


Expectations

• Collaboration vs Hard Core battle

• Medical Director be present for introductions and PI / chart review

• TPM all day

• Registrar available / Report generation

• Letter of Commitment from the Board

• Working room for the day

• Evidence of loop closure projectsType the footnote/source in this space


Typical Schedule

• 9-10 am - meet and greet / Opening presentation ( include VP )

• 10-1130 Tour and asking questions

• 1130 – 1330 working lunch, chart review and PI

Injury prevention activities

• 1330 Exit interview ( TMD, VP )



Meet and greet / Exit interview

• Main players of the trauma system

• Difference between East III - N/S/W Level III

• TPM, TMD, Registrar

• ED MD director, ED RN director

• Lab, Radiology, VP, OR Director, CC Director,

EMS Liaison

• “Who we are” presentation



The Tour

• Follow the Check list

• Follow the flow of the patient through the system

• Helipad and EMS bay – Safety, Communication

• Resuscitation room – Equipment and Team

• Lab – standardized protocols/blood

• Radiology – standardized protocols/need for CT

• Operating Room and Critical CareType the footnote/source in this space


The People “TEAM”

• Level III Surgeon or MD response and tracking

• ATLS for MDs, TNCC or RTTDC for RNs

• Continuing education

• Are they showing up to the traumas



Trauma PIPS

• How do you know you are doing a good job?

• If something happens how do YOU keep from having that occur ever again in your institution?

• Chart review – Deaths, ISS > 15, transfer outs

• Registry Data

• Meeting minutes; Systems – Peer review

• Highlight loop closure



PIPS

• Real time

-rounding

-daily log

• Retrospective review / Registry data (Pre-chart)

-TMP or designee reviews every single chart

-TPM and TMD review “fall outs”

- Committee review; Systems or Peer ReviewType the footnote/source in this space


PIPS – TPM and TMD – Your Gang decides• • Patient with a Glasgow Coma Scale <14 who did not receive a CT of the head

• • Absence of at least hourly determination and recording of BP, pulse, respirations, and GCS for any trauma patient beginning with arrival in ED, including time spent in radiology, up to transfer to the ward, OR, ICU, death, or transfer to another hospital

• • Comatose trauma patient leaving ED before definitive airway (endotracheal tube or surgical airway) is established

• • Any patient sustaining a GSW to the abdomen who is managed non-operatively

• • Patient with abdominal injuries and hypotension (SBP<90) who does not undergo a laparotomy within 1 hour of ED arrival, or patient undergoing a lapartomy >4 hours after arrival in the ED

• • Patient with epidural or subdural brain hematoma receiving craniotomy more than 4 hours after arrival at ED, excluding those performed for ICP monitoring

• • Patient transferred out >3 hours after ED arrival

• • Interval of >8 hours between arrival and initiation of debridement of an open tibial fracture, excluding a low velocity gunshot wound

• • Abdominal, thoracic, vascular, or cranial surgery performed >24 hours after arrival

• • Trauma patient admitted to the hospital under care of admitting or attending physician who is not a surgeon and ISS >9

• • Non-fixation of femoral diaphyseal fracture in adult trauma patient

• • Any patient requiring reintubation of the airway within 48 hours of extubation

• •Transfusion of > 4units PRBCs ro activation of Massive transfusion protocol ; Patients receiving Factor VIIa

• • All trauma deaths

• All pediatric patients ISS > 16 , Patients with ISS > 25

• Re-admission ; Return to ICU

• "Significant events" ie Code Blue, crushing up Vicodin and trying to inject it into their IV



PIPS

• Systems issue – Multi-disciplinary –

• Not Peer Review

• Sign in please

• Minutes complete and system orientated

CXR not available in timely fashion to ED MD

Standard lab draw list for every trauma Red

Blood warming devise in the trauma bay

Hover mats



PIPS

• Peer Review – MDs ( Surgeon, ED ) and TPM

Peer review protected

No surprises

Adults only please ( Professionalism), Sign in, Minutes sparse

All trauma deaths ( 3 possible judgments)

Missed intubations

Subcutaneous chest tubes

Massive blood transfusion review



PIPS

• Individual Counseling

• Conversation or a letter ( see example )

• MM presentation and Article



PIPS – Simple Documentation

• Loop Closure CXR not available in timely fashion to ED MD

Standard lab draw list for every trauma Red

Blood warming devise in the trauma bay



Exit Interview

• Reviewers need about 20 minutes “alone”

• Verbal Report

Strengths

Opportunities for improvement

Criteria Deficiencies

Attendance List

Recommendations:

Pass, Focus visit, Paper visit

Case Reviews



Closing

• Site reviewers will not give designation

• Generate a report and submit to CRC

• CRC makes recommendation to DHS

• DHS sends out 3 yr certificate and letter to CEO



Questions



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• First subpoint

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• Etc, etc, etc…

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YearsType the footnote/source in this space


Title for TableSubtitle for Table

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Row 1 Red 12.3 47% P<0.001

Row 2 Yellow 459.2 26% P=0.05

Row 3 Green 56.7 98% NS

Row 4 Blue 1.0 2% P>0.01

Row 5 Pink 56.9 14% P<0.0001

Row 6 Violet 25.4 35% P=0.01

Row 7 Orange 1,256.2 5% P<0.001



Title for Organizational ChartSubtitle for Organization Chart

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Box 2 Box 4 Box 5Box 3

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Mayo ClinicLocations


Questions & Discussion


Presentation Grid System (4:3 Ratio)

trauma site visits

Documents

space2011 mfmer slide

tmd review

trauma pips

chart review deaths

chart reviewtype

pi chart reviewtpm

pips systems

single charttpm