2013 Trauma Annual ReportMercy Hospital and Trauma Center

Offering trauma patients the best possible outcome ... a second chance at life

Messages 1Who we are 2Our trauma team 3MD-1 in the field 4Trauma defined 5Mercy trauma statistics: 2013 6-8Quality improvement 9Sexual trauma 10Hospital-based services 11-12Preventing injury 13

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Trauma center messages

From the president

According to the Centers for Disease Control, injury is the leading cause of death for Americans 44 yearsof age and younger. As the only Level II trauma center in south-central Wisconsin, Mercy Hospital andTrauma Center is helping reduce the rates of disability and death associated with injury.

Our multi-disciplinary team of certified trauma surgeons and nurses, emergency medicine physicians, neurosurgeons, orthopaedic surgeons, ENTs, heart and vascular surgeons, plastic and reconstructivesurgeons, anesthesiologists and other specialists and staff provide leading-edge care to severely injured patients. See page 3 for a full listing of the many disciplines that comprise our trauma team.

As a Level II trauma center, we are committed to providing the necessary resources to meet the needsof our community, and we are making a difference. In 2013, Mercy gave more than 800 trauma patientsa second chance at life. This commitment and dedication will continue into the future for the good of all of our patients.

This 2013 annual report allows us to highlight some of the things Mercy is doing to revolutionize criticalcare for the residents across our region. Thank you for supporting us on our journey.

Regards,Javon R. Bea, President/CEO, Mercy Health System

From the trauma medical director

It is an honor and privilege to be part of developing Mercy’s emergency services into a Regional ACS(American College of Surgeons) Verified Level II Trauma Center with acute care surgical services, a JointCommission Verified Primary Stroke Center; and a Society of Chest Pain Centers Accredited Chest PainCenter. These services have made critical, intensive and specialty services available to our patients close to home at our community hospital.

The growth and refinement of these services decreased trauma patients transferred to other trauma centers from 20% in 2008 to 4% in 2013. The most critical patients are able to stay in our community from the time when EMS and MD-1 physicians respond to events and bring patients to our state-of-the-artemergency department, operating rooms and intensive care unit. They continue to receive excellent carethrough their rehabilitation in our Comprehensive Inpatient Rehabilitation unit, and follow-up in our clinics and with their own Mercy primary care doctors. The positive impact these services have made on our patients and their families is substantial.

Our team of medical experts provides exceptional services and care to our neighbors in need. Countlessstaff and ancillary personnel also ensure they meet the best possible outcome. Our colleagues includeparamedics, local emergency volunteers, referring facilities, nurses, laboratory personnel, respiratory therapists, medical imaging staff, physical/occupational therapists, speech pathologists, dietitians, social workers, case managers, palliative care nurses and chaplains.

We strive to provide the best care possible to all patients who present to our trauma center. This annualreport describes our 2013 efforts in achieving that goal. Our thanks go again to the many trauma careproviders at Mercy Hospital and Trauma Center and across our region who work hard every day to care for the injured.

Wishing you good health,Robb Whinney, DO, Medical director, Mercy Hospital and Trauma Center trauma department

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At Mercy Hospital and Trauma Center, we offer critically injured patients immediate, life-saving care close to home, 24 hours a day, seven days aweek, 365 days a year, and continue to care for most injured patients through their entire course of hospital care and rehabilitation.

Our trauma services go well beyond the emergency department. Mercy’s multi-disciplinary trauma and critical care team is ready at a moment’s notice to carefor the most severely injured patients. Everything isin place upon the patient’s arrival: doctors, surgeons,nurses, imaging equipment, operating rooms andsupport staff.

Mercy Hospital and Trauma Center is the only Level IITrauma Center south of La Crosse as verified by the American College of Surgeons Committee on Trauma. We treat more than 800 trauma patients annually.

Our missionTo reduce regional trauma-related death and disability by providing seamless care resulting in healing in the broadest sense.

Our visionWe are committed to provide:

• Regional trauma leadership• Community injury prevention education• Education to those who care for the injured• The highest quality care through continuous

performance improvement

Who we are

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Medical providers• Robb Whinney, DO, FACOS, medical director,

trauma and acute care surgery• Alissa DeVos, PA-C, trauma and acute care surgery• Krista Kimball, PA-C, trauma and acute care surgery• Derek Wall, MD, trauma and acute surgery• Patricia Garner, MD, general surgery• Ancil Philip, MD, general surgery

Program staff• Anne Quaerna, RN, MSN, director of ED, EMS and trauma• Lori McKibben, RN, BSN, MBA, trauma program coordinator• Terry Michel, injury prevention coordinator• Barbara Hermening, RN, trauma registrar• Diane Eppihimer, RN, trauma and acute care clinic• Kate Ayers, CMA, trauma and acute care clinic

We work closely with local emergency responders,surrounding hospitals and trauma centers to give our trauma patients rapid, high-quality care.

Mercy also addresses secondary trauma—the effects that the injured individual’s loved ones must deal with. Our chaplains, social workers and care coordinators are here to gently guide patients and families from the initial injury through the entire hospital and recovery phase.

Our trauma team Our full hospital trauma team includes:

• Emergency doctors and nurses

• Trauma surgeons and nurses

• Neurosurgeons

• Cardiothoracic surgeons

• Orthopaedic surgeons

• Vascular surgeons

• Ear, nose and throat surgeons

• Plastic and reconstructive surgeons

• Ophthalmologists

• Anesthesiologists

• Radiologists/interventional radiologists

• Critical care specialists

• Hospitalists

• Chaplains

• Laboratory and blood bank technicians

• Diagnostic imaging technicians

• Inpatient nursing staff

• Respiratory therapists

• Social services staff

• Dietitians

• Palliative care specialists

• Inpatient and outpatient rehabilitation staff

• Trauma clinic follow-up care staff

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MD-1 is a first for Rock County and one of only a few in the nation. This medically equipped and emergencymedicine physician-staffed Chevy Tahoe is based atMercy Hospital and Trauma Center. MD-1 is used for difficult and prolonged extrications or situations where an on-the-scene physician may be able to provide additional medications and resources.

EMTs and paramedics are equipped and trained to handle a vast array of emergency medical conditions

using physician-authorized protocols. Mercy’s MD-1program is designed to augment, not replace, existingcommunity EMS resources in the community. When EMS crews feel it is appropriate and necessary, MercyEMS physicians will respond in MD-1 to their request any time, day or night.

MD-1 has responded to over 250 calls since inceptionin 2012. In August 2014, we added an MD-1 vehicle toour Walworth County service area.

Mercy’s MD-1 bringsphysicians to emergencies

MD-1 physicians (pictured above)• Jay MacNeal, DO, MPH, NREMT-P, EMS medical director• Christopher Wistrom, DO, NREMT-P, associate EMS medical director• Todd Daniello, MD, NREMT-P, associate EMS medical director• Sean Marquis, MD, NREMT-P, associate EMS medical director

Pictured (L-R): Dr. Jay MacNeal, Dr. Christopher Wistrom, Dr. Sean Marquis and Dr. Todd Daniello.

According to the American Trauma Society, trauma is asevere blunt or penetrating injury primarily caused byautomobile crashes, gunshots, knife wounds, falls, batteryor burns. The Centers for Disease Control’s (CDC) fieldtrauma triage guidelines recommend trauma centers for these types of patients because of improved outcomes. The CDC rates injury as the leading cause of death for American children and adults ages one to 44.

Minor injuries can also be treated at a trauma center,and will typically be handled by an emergency medicinephysician with backup from other medical specialists.

Level I trauma carePatients who require certain sub-specialties may be transferred to a Level I trauma center, includingUniversity of Wisconsin Hospital and Clinics in Madisonand Froedtert Hospital in Milwaukee. These facilities are equipped to accept:

• Critical burn patients who meet burn center criteria

• Critical pediatric (younger than 15) patients who require intensive care monitoring

• Complex pelvic fracture patients who requiretrauma-trained orthopaedic surgeons

• Amputations with the possibility of re-implantation

In addition to Level II criteria, Level I trauma centersalso provide emergency and surgical residency programs and participate in trauma-relatedresearch activities.

Level II trauma careThese facilities have resources available 24/7 to carefor the majority of injured patients. Key elementsinclude 24-hour coverage by general surgeons andprompt availability of care in varying specialties such as orthopaedic surgery, neurosurgery, plastic surgery,anesthesiology, emergency medicine, radiology, internalmedicine, oral and maxillofacial surgery, otolaryngologyand critical care, which are needed to adequately respond and care for various forms of trauma that a patient may suffer.

Level II facilities accept patients transferred from Level III and Level IV facilities. In addition, Level II facilities take part in community injury prevention and outreach education initiatives, and are involvedwith local and state government issues related totrauma care and prevention.

Level III trauma careThese facilities, often community hospitals, generallyhave resources available to treat and stabilize the majority of injured patients, however, these resourcesmay not be available 24/7.

Level IV trauma careThis is available at settings such as urgent care centersand physician clinics. Minimal resources are available,but they have procedures in place to immediately transfer injured patients to a higher level of care.

Trauma defined

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Mercy Hospital and Trauma Center statistics: 2013

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Injury severity score (ISS)

Trauma patients

Mechanism of injury

Discharged from ED

No activation: 45%

Full: 11%

Modified: 34%

ED response: 10%

1%

57%

87%

Full Modified ED

9-15: 22%

1-8: 71%16-24: 4%

25-40: 2%

>41: 1%

Fall: 42%

Pedestrian: 2%

Motorcycle: 5% Stabbing: 1%

Firearm: 1%

Other: 11%

Motor vehicle: 38%

ISS is an established medical score to assess trauma/injuryseverity. It correlates with mortality, morbidity and hospitallength of stay. The higher the ISS, the more severely injuredthe patient, with a score of 15 or greater defining a majortrauma patient.

Full Potential life-threatening injuries; may require immediate surgical intervention

Modified Significant mechanism of injury, stable injuries; may require surgical consult

ED response Minor mechanism of injury, minor injuries; usually does not require surgical consult

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trauma patientspatient disposition

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ems agency

injury severity

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trauma patientspatient disposition

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trauma patientspatient disposition

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Mercy Hospital and Trauma Center statistics: 2013

Mode of arrival

EMS agency

Patient disposition

Ground basic lifesupport: 23%

We see our EMS partners as an invaluable extension of the exceptional trauma care our patients receive in thehospital. Improved outcomes for trauma patients areclosely linked to adequate early resuscitation and timelytransfer of appropriate patients to trauma centers (WI State Trauma Triage and Transfer Guideline). Studiesshow that the sooner a trauma patient can get to definitive care, the better their outcome.

Ground advanced life support: 50%

Per own vehicle: 21%

Helicopter: 6%

Discharged from ED: 26%Transfer out: 4%

Deaths: 2%

Admits: 68%

Janesville 56%

6% Beloit

8% Milton

1% Clinton

4% Edgerton

1% Orfordville

3% Footville1% Town of Beloit

2% Paratech2% Whitewater

4% Evansville

2% Brodhead

7% other

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trauma patientspatient disposition

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mechanismmode of arrival

ems agency

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Mercy Hospital and Trauma Center statistics: 2013

GenderAge

Average length of stay

59% 41%

15-55 yrs: 53%

>55 yrs: 39%

<15 yrs: 8%

3 days

5 days

ICU Hospital

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Lori McKibben, RN, BSN, MBA, trauma program coordinator

The hallmark of any trauma center is a continuous process of measurement, assessment and management directedat improving patient care.

We strive to continually make the changes that will lead to better patient outcomes, better systemperformance and better professional development.

The process of performance improvement reviews the entire continuum of patient care, from the initialscene response through acute care, rehabilitation andreintegration back into the community. Performanceimprovement is data-driven and outcomes-focused.Through data measurement, issue identification,

action and reevaluation, care is directly improved at the bedside, throughout the system and within the region.

Our goal is to build a trauma system that coordinates theefforts of all team members to improve the outcomes of traumatically injured patients in our region.

Pre-hospital providers should strive for a scene timeless than 20 minutes. Referral hospitals should aim to transfer patients within 3 hours. Tertiary facilitiesmust strive to quickly and thoroughly assess the patient and provide life-saving interventions.

Our ultimate goal is to improve the care being given to patients as a means to reduce their morbidity andmortality. In 2013, Mercy Hospital and Trauma Centertrauma patients had a mortality rate of only 2%.

Continually improving our quality

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Jackie Friar-LeCaptain, RN, SANE program coordinator

When a person’s traumatic injuries are caused by sexual assault, Mercy Hospital and TraumaCenter offers round-the-clock compassionate care through its SANE (sexual assault nurseexaminer) program. Mercy’s SANE program, the only one of its kind in Rock County, providescomprehensive care for sexual assault victims of all ages.

Mercy’s sexual assault nurse examiner is a registered nurse who has specialized educationand has fulfilled clinical requirements to perform forensic examinations of patients who report sexual assault. She offers:

• Full attention focused on the care and comfort of the patient• Emergency health services• Expertise to offer effective courtroom testimony• Definitions of consent and sexual assault• Community education about preventing sexual abuse• Access to important local resources

Mercy Hospital and Trauma Center expanded its emergency services to include a SANE program in July 2008 to give Rock County the necessary services and the support it needs to care for victims of sexual assault. Since then, we have cared for 864 sexualassault patients.

For details about Mercy’s SANE program, call (608) 756-6522.

Sexual trauma

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Primary Stroke Center improves outcomesNichelle Jensen, BSN, RN, CCRN, stroke program coordinator

Mercy Hospital and Trauma Center has advanced certification as a Primary StrokeCenter by the Joint Commission. Mercy isthe first and only hospital in the area to receive this level of certification.

We have a full team of experts dedicated to caring for people who are having or have had a stroke. Our initial Code Stroke services include fast diagnosis and treatment. Our gold standard of treatment is administering a clot-busting drug—for those who qualify—within 60 minutes of arrival. The national rateof thrombolytic therapy for ischemic stroke patients is6%. In 2013, Mercy’s thrombolytic therapy rate was 10%.This shows Mercy’s commitment to aggressive stroketherapy.

We also offer complete inpatient and outpatient rehabilitation services, plus a stroke survivors’ supportgroup. Mercy Hospital and Trauma Center has a declaredand established commitment for acute stroke care.

Certified Primary Stroke Center

Our Stroke Center resourcesThese are the major areas that Mercy Hospital and Trauma Center was required to have to becomea certified Primary Stroke Center:

• A 24-hour acute stroke team, including neurology, ED, and critical care physicians and nurses• 24-hour access to a neurosurgical surgeon and neurosurgical services• CT or MRI available 24/7• Rapid assessment of priority labs and CT/MRI scans for acute stroke patients• Designated stroke units with specially trained staff• Written tPA protocol in the ED and inpatient units• Written acute stroke clinical pathways (detailed, evidence-based care plans)• Regular stroke education sessions for all stroke staff• Long-term follow-up for stroke treatment outcomes and quality improvement

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Accredited Chest Pain Center

Our cardiac resources• Receiving station for EMS 12-lead EKGs• Immediate notification of cardiology for STEMI• 24/7 cardiac catheterization lab• Cardiothoracic surgery• Therapeutic hypothermia, which greatly improves both ROSC and neurologic outcomes

of cardiac arrest patients• Rapid laboratory response to STEMI patients• Bedside digital x-ray for STEMI patients• Emergency pacemaker placement

Heart care at its bestLaura Kingsbury, RN, BSN, TNS, chest pain program coordinator

Chest Pain Center — As an accreditedchest pain center, Mercy Hospital andTrauma Center has resources fully inplace to reduce the time from the onsetof a person’s heart attack symptoms to diagnosis and treatment. We treat patients faster during the critical window of time when the heart musclecan be preserved.

Through the use of 12-lead, pre-hospital EKGs, our heart catheterization lab times are better than the national average. Our state-of-the-art monitoringwatches patients when it is not certain they are having a heart attack; this means they are not senthome too quickly and we are sure they receive the best treatment for their condition.

Code STEMI — STEMI is an abbreviation for ST-elevationmyocardial infarction. It’s a severe heart attack causedby a prolonged period of blocked blood supply to a largearea of the heart. Mercy’s Code STEMI team assesses,treats and supports these patients as fast as possiblebecause crucial minutes are at stake. The national standard for STEMI treatment is 90 minutes. In 2011,Mercy’s average was 49 minutes. When time is muscle,it is important to open the obstructed cardiac vessel as soon as possible.

For recovery from a heart attack or heart surgery, our cardiopulmonary rehabilitation programs helps patients return to a healthier quality of life.

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Terry Michel, injury prevention coordinator

Because our mission is to reduce regionaltrauma-related death and disability, MercyHospital and Trauma Center is committedto injury prevention through many community outreach initiatives.

ThinkFirstThis nationwide, award-winning, evidence-based program teaches young people how to avoid or reducetheir chances of being injured. Mercy implemented the ThinkFirst program as part of its trauma educationinitiative.

Our ThinkFirst coordinators provide education for third- and fourth-grade students in Rock County andsurrounding areas. They visit schools to teach kids about the importance of thinking first to stay safein any activity. Our program features Street Smart, Mercy’s popular mascot and safety superhero. We provided 91 ThinkFirst programs in 2013, reachingover 1,800 local school children.

To learn more, call our ThinkFirst coordinators at (608) 743-2060.

Concussion services Even when it’s mild, a concussion can be a real braininjury that requires medical attention to prevent further problems. Project ImPACT is part of a nationalconcussion screening and follow-up program Mercy offers to schools and head trauma patients. In the past year, Mercy has performed 203 baseline tests and 121 post-injury assessments.

To learn more, call Mercy Sports Medicine and Rehabilitation Center in Janesville at (608) 754-6000.

Distracted Driver Pledge In the US, unintentional traffic accidents are theleading cause of death in individuals aged one to 34. Increasingly, accidents are caused by distracted drivers.All distractions endanger driver, passenger, and bystander safety. These types of distractions include:

• Texting• Using a cell phone or smartphone• Eating and drinking• Talking to passengers• Grooming• Reading, including maps• Using a navigation system• Watching a video• Adjusting a radio, CD player or MP3 player

Our Distracted Driver Pledge can be found athttp://goo.gl/WeYzrp. Print it and share it with your loved ones.

Driver Assessment Program Mercy designed this program to determine a person’sability to drive safely, whether they’re recovering from an illness or injury or are simply concerned about howaging has affected their driving skills. In the past year,Mercy occupational therapists completed 18 driver assessments.

The program is headquartered at the Mercy OccupationalConditioning Center in Janesville. To learn more, call(608) 755-7998.

CPR and first aid classes for the public can bescheduled through our Mercy Regional Emergency Medical Services Training Centers in Janesville and Lake Geneva. For more information, call Janesville at (608) 756-6182 or Lake Geneva at (262) 245-2195.

Preventing injury

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Street Smart supporting our communities

Doing whatever it takes to see you well.