Transcript MCHS Blue Stacked 4x3.pot

Trauma Site Visits
Wayne Street RN
Meeting Name Here
And Date Here
City – Location Identity
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Objectives
• Level III and Level VI trauma site visit
• The pre-meeting conference
• Facility Commitment
• The Tour
• PI and Chart review
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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 projects
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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 )
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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
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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 Care
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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
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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?
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Chart review – Deaths, ISS > 15, transfer outs
Registry Data
Meeting minutes; Systems – Peer review
Highlight loop closure
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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 Review
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PIPS – TPM and TMD – Your Gang decides
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• •
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
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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
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Patient transferred out >3 hours after ED arrival
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Abdominal, thoracic, vascular, or cranial surgery performed >24 hours after arrival
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Non-fixation of femoral diaphyseal fracture in adult trauma patient
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Any patient requiring reintubation of the airway within 48 hours of extubation
Interval of >8 hours between arrival and initiation of debridement of an open tibial fracture, excluding a
low velocity gunshot wound
Trauma patient admitted to the hospital under care of admitting or attending physician who is not a
surgeon and ISS >9
•Transfusion of > 4units PRBCs ro activation of Massive transfusion protocol ; Patients receiving Factor VIIa
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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
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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
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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
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PIPS
• Individual Counseling
• Conversation or a letter ( see example )
• MM presentation and Article
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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
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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
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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
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Title Here
Subtitle Here
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• Type your second bulleted point here
• First subpoint
• Second subpoint
• Type your third bulleted point here
• Etc, etc, etc…
• Etc, etc, etc…
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Title for Chart
Subtitle for Chart
100
80
East
West
North
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%
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0
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
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Title for Chart
Subtitle for Chart
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Title for Chart
Subtitle for Chart
100
80
East
West
North
60
%
40
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0
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
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Title for Chart
Subtitle for Chart
100
East
West
North
80
60
%
40
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0
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1
2
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5
Years
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Title for Table
Subtitle for Table
Column 1
Row 1
Column 2
Red
Column 3
12.3
Column 4 Column 5
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%
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
P>0.01
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Title for Organizational Chart
Subtitle for Organization Chart
Box 1
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Box 5
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Box 9
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Mayo Clinic
Locations
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Questions & Discussion
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Presentation Grid System (4:3 Ratio)
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