Trauma Site Visits
description
Transcript of Trauma Site Visits
©2011 MFMER | slide-1
Trauma Site Visits
Wayne Street RN
Meeting Name HereAnd Date Here
City – Location Identity
©2011 MFMER | slide-2
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
©2011 MFMER | slide-3
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
©2011 MFMER | slide-4
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 )
Type the footnote/source in this space
©2011 MFMER | slide-5
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
Type the footnote/source in this space
©2011 MFMER | slide-6
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
©2011 MFMER | slide-7
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
Type the footnote/source in this space
©2011 MFMER | slide-8
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
Type the footnote/source in this space
©2011 MFMER | slide-9
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
©2011 MFMER | slide-10
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
Type the footnote/source in this space
©2011 MFMER | slide-11
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
Type the footnote/source in this space
©2011 MFMER | slide-12
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
Type the footnote/source in this space
©2011 MFMER | slide-13
PIPS
• Individual Counseling
• Conversation or a letter ( see example )
• MM presentation and Article
Type the footnote/source in this space
©2011 MFMER | slide-14
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
Type the footnote/source in this space
©2011 MFMER | slide-15
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
Type the footnote/source in this space
©2011 MFMER | slide-16
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
Type the footnote/source in this space
©2011 MFMER | slide-17
Questions
Type the footnote/source in this space
©2011 MFMER | slide-18
Title Here
• Type your first bulleted point here
Type the footnote/source in this space
©2011 MFMER | slide-19
©2011 MFMER | slide-20
©2011 MFMER | slide-21
©2011 MFMER | slide-22
©2011 MFMER | slide-23
©2011 MFMER | slide-24
Title Here Subtitle Here
• Type your first bulleted point here
• Type your second bulleted point here
• First subpoint
• Second subpoint
• Type your third bulleted point here
• Etc, etc, etc…
• Etc, etc, etc…
Type the footnote/source in this space
©2011 MFMER | slide-25
Title for ChartSubtitle for Chart
0
20
40
60
80
100
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
%
EastWestNorth
Type the footnote/source in this space
©2011 MFMER | slide-26
Title for ChartSubtitle for Chart
Type the footnote/source in this space
©2011 MFMER | slide-27
Title for ChartSubtitle for Chart
0
20
40
60
80
100
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
%
EastWestNorth
Type the footnote/source in this space
©2011 MFMER | slide-28
Title for ChartSubtitle for Chart
0
20
40
60
80
100
0 1 2 3 4 5
%
EastWestNorth
YearsType the footnote/source in this space
©2011 MFMER | slide-29
Title for TableSubtitle for Table
Column 1 Column 2 Column 3 Column 4 Column 5
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
Type the footnote/source in this space
©2011 MFMER | slide-30
Title for Organizational ChartSubtitle for Organization Chart
Box 1
Box 2 Box 4 Box 5Box 3
Box 6 Box 7 Box 8 Box 9
Type the footnote/source in this space
©2011 MFMER | slide-31
Mayo ClinicLocations
©2011 MFMER | slide-32
Questions & Discussion
©2011 MFMER | slide-33
Presentation Grid System (4:3 Ratio)