Trauma Redesign Process
1
Conference Abstracts 147 tiatives developed and the subsequent challenges of implementation. Keywords: Traumatic brain injury; Abbreviated Westmead Post-Traumatic Amnesia Scale; Westmead Post-Traumatic Amnesia Scale; Post-traumatic amnesia; Emergency doi:10.1016/j.aenj.2010.08.287 Priority Zero—–The Red Blanket Reducing the transfer delay of the trauma patient from the Emergency Department to the Operating Room Kerena Grant , Michael Handy Royal Brisbane & Women’s Hospital, Level 2 James Mayne Building, Herston Rd., Herston, Brisbane, QLD 4029, Aus- tralia E-mail addresses: Kerena [email protected] (K. Grant), William [email protected] (M. Handy). Introduction: Severely injured trauma patients fre- quently require operative management to stem exsanguina- tion. An internal audit conducted within the Royal Brisbane and Women’s Hospital identified delays in the transfer of non-responding hypotensive trauma patients from the Emer- gency Room (ER) to the Operating Room (OR). As a result the Red Blanket process was adapted from Los Angeles County Trauma Centre and implemented. The Red Blanket is a pro- cess of rapid transfer to the OR that bypasses a number of the normal procedures such as consent, property lists, pre op check lists and anaesthetic availability. Data methods: Data were retrospectively collected from the Queensland Trauma Registry (January 2006 to October 2007) and prospectively by the Trauma Service based on doc- umented activation of the Red Blanket Protocol (November 2007 to February 2010). Inclusion criteria included trauma patients with a systolic blood pressure of ≤90 who failed to respond to initial fluid resuscitation or required damage control surgery with an ISS >16. ED to OR transfer time was calculated from time of ED arrival until time of OR arrival and process times were compared. Results: Pre-implementation identified 12 cases (8 male) with a mean age of 49 yrs (range, 30—84 yrs) and a mean transfer time of 206 ±SD 140 min (median189). Post- implementation identified 20 cases (11 male) with a mean age of 35 yrs (range, 18—77 yrs) and a mean transfer time of 19 ±SD 11 min (median17) from ED to OR. This difference is statistically significant (p < 0.005). Conclusion: Results suggest that implementation of the Red Blanket protocol contributed to a reduction in mean transfer time from ED to OR by 187 min. Further decrease in transfer time may be achieved with additional research and education. Keywords: Trauma; Damage control surgery; Emergency Department; Operating theatre; Protocol doi:10.1016/j.aenj.2010.08.288 Trauma Redesign Process Margaret Murphy , Carla Edwards b , Julie Seggie c a Emergency Department, Emergency Services, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145, Australia b The Centre for Health Innovation & Partnership, Westmead Hospital, Australia c Trauma Services, Westmead Hospital, Australia E-mail addresses: Margaret [email protected] (M. Murphy), carla [email protected] (C. Edwards), Julie [email protected] (J. Seggie). Keywords: Trauma team training using simulation; Trauma team redesign; Contextualising trauma team training to one’s own local environment; Organisational change using redesign methodology; Training the entire trauma team; Simulation; Education doi:10.1016/j.aenj.2010.08.289 Clinical 3C Emergency to Rapid Access for TIA: Optimising diagnostics and secondary prevention in a regional setting Sharan Ermel , Lily Samson, Penni Edwards Bendigo Health, PO Box 126, Bendigo, Victoria 3552, Aus- tralia E-mail address: [email protected] (S. Ermel). Transient Ischaemic Attack (TIA) presentations to emer- gency departments pose a clinical dilemma for clinicians. Access to inpatient beds and neurology expertise is restricted, especially in rural and regional areas. Evidence indicates that acute TIA presentations warrant a full assess- ment and diagnostic evaluation within 24 h of onset for high risk presentations, and within a maximum of 72 h for low risk presentations. 1 In an audit undertaken at a Victorian regional health service emergency department (ED), it was found that these recommendations were not being realised. Of the cohort discharged directly from ED (n = 20), repre- senting 29% of ED TIA discharges, 85% underwent a computed tomography of the brain (CTB) while in ED, and 65% had pathology drawn. Only 35% of TIA discharges underwent carotid doppler studies, with the mean delay of 8.9 days. Only 35% of the cohort were discharged on anti-platelet agents, and 15% on lipid-lowering medication. Lifestyle behaviour modification advice was provided to only 30% of the discharged cohort. Ten percent of TIA patients dis- charged from ED, re-presented within 28 days with either TIA or stroke. In the absence of a dedicated TIA clinic, the ED collaboratively developed a pathway to the Rapid Access Clinic (RAC). The pathway includes risk stratifi- cation and admission criteria, evidence-based assessment requirements and secondary prevention recommenda- tions. All TIA patients being discharged to the RAC receive request slips for outpatient carotid dopplers, fasting pathology and cardiac echo, as well as TIA patient education, and RAC information. In addition, patients are being referred to the ED Hospital Admission Risk Program (ED-HARP) for co-ordination of appoint-
-
Upload
margaret-murphy -
Category
Documents
-
view
215 -
download
3
Transcript of Trauma Redesign Process
T
M
a
Hb
Hc
E(J
KtorS
d
C
Ea
S
t
E
gArimrrrfOstpcOabocT
E
Conference Abstracts
tiatives developed and the subsequent challenges ofimplementation.
Keywords: Traumatic brain injury; Abbreviated WestmeadPost-Traumatic Amnesia Scale; Westmead Post-TraumaticAmnesia Scale; Post-traumatic amnesia; Emergency
doi:10.1016/j.aenj.2010.08.287
Priority Zero—–The Red Blanket
Reducing the transfer delay of the trauma patient fromthe Emergency Department to the Operating Room
Kerena Grant, Michael Handy
Royal Brisbane & Women’s Hospital, Level 2 James MayneBuilding, Herston Rd., Herston, Brisbane, QLD 4029, Aus-tralia
E-mail addresses: Kerena [email protected] (K.Grant), William [email protected] (M. Handy).
Introduction: Severely injured trauma patients fre-quently require operative management to stem exsanguina-tion. An internal audit conducted within the Royal Brisbaneand Women’s Hospital identified delays in the transfer ofnon-responding hypotensive trauma patients from the Emer-gency Room (ER) to the Operating Room (OR). As a result theRed Blanket process was adapted from Los Angeles CountyTrauma Centre and implemented. The Red Blanket is a pro-cess of rapid transfer to the OR that bypasses a number ofthe normal procedures such as consent, property lists, preop check lists and anaesthetic availability.
Data methods: Data were retrospectively collected fromthe Queensland Trauma Registry (January 2006 to October2007) and prospectively by the Trauma Service based on doc-umented activation of the Red Blanket Protocol (November2007 to February 2010). Inclusion criteria included traumapatients with a systolic blood pressure of ≤90 who failedto respond to initial fluid resuscitation or required damagecontrol surgery with an ISS >16. ED to OR transfer time wascalculated from time of ED arrival until time of OR arrivaland process times were compared.
Results: Pre-implementation identified 12 cases (8 male)with a mean age of 49 yrs (range, 30—84 yrs) and amean transfer time of 206 ±SD 140 min (median189). Post-implementation identified 20 cases (11 male) with a meanage of 35 yrs (range, 18—77 yrs) and a mean transfer timeof 19 ±SD 11 min (median17) from ED to OR. This differenceis statistically significant (p < 0.005).
Conclusion: Results suggest that implementation of theRed Blanket protocol contributed to a reduction in meantransfer time from ED to OR by 187 min. Further decrease intransfer time may be achieved with additional research andeducation.
Keywords: Trauma; Damage control surgery; EmergencyDepartment; Operating theatre; Protocol
doi:10.1016/j.aenj.2010.08.288
AcrtrfppR
147
rauma Redesign Process
argaret Murphy, Carla Edwardsb, Julie Seggiec
Emergency Department, Emergency Services, Westmeadospital, PO Box 533, Wentworthville, NSW 2145, AustraliaThe Centre for Health Innovation & Partnership, Westmeadospital, AustraliaTrauma Services, Westmead Hospital, Australia
-mail addresses: Margaret [email protected]. Murphy), carla [email protected] (C. Edwards),ulie [email protected] (J. Seggie).
eywords: Trauma team training using simulation; Traumaeam redesign; Contextualising trauma team training tone’s own local environment; Organisational change usingedesign methodology; Training the entire trauma team;imulation; Education
oi:10.1016/j.aenj.2010.08.289
linical 3C
mergency to Rapid Access for TIA: Optimising diagnosticsnd secondary prevention in a regional setting
haran Ermel, Lily Samson, Penni Edwards
Bendigo Health, PO Box 126, Bendigo, Victoria 3552, Aus-ralia
-mail address: [email protected] (S. Ermel).
Transient Ischaemic Attack (TIA) presentations to emer-ency departments pose a clinical dilemma for clinicians.ccess to inpatient beds and neurology expertise isestricted, especially in rural and regional areas. Evidencendicates that acute TIA presentations warrant a full assess-ent and diagnostic evaluation within 24 h of onset for high
isk presentations, and within a maximum of 72 h for lowisk presentations.1 In an audit undertaken at a Victorianegional health service emergency department (ED), it wasound that these recommendations were not being realised.f the cohort discharged directly from ED (n = 20), repre-enting 29% of ED TIA discharges, 85% underwent a computedomography of the brain (CTB) while in ED, and 65% hadathology drawn. Only 35% of TIA discharges underwentarotid doppler studies, with the mean delay of 8.9 days.nly 35% of the cohort were discharged on anti-plateletgents, and 15% on lipid-lowering medication. Lifestyleehaviour modification advice was provided to only 30%f the discharged cohort. Ten percent of TIA patients dis-harged from ED, re-presented within 28 days with eitherIA or stroke.
In the absence of a dedicated TIA clinic, theD collaboratively developed a pathway to the Rapidccess Clinic (RAC). The pathway includes risk stratifi-ation and admission criteria, evidence-based assessmentequirements and secondary prevention recommenda-ions. All TIA patients being discharged to the RACeceive request slips for outpatient carotid dopplers,
asting pathology and cardiac echo, as well as TIAatient education, and RAC information. In addition,atients are being referred to the ED Hospital Admissionisk Program (ED-HARP) for co-ordination of appoint-
