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Trauma & Acute Care S urgery
S ystems of Care S ymposium Travis Littman MD, F ACS April 18, 2015
Disclosures
- No Financial Disclosures or Conflicts of Interest
Trauma & Acute Care S urgery S ystems of Care S ymposium - - PowerPoint PPT Presentation
Trauma & Acute Care S urgery S ystems of Care S ymposium - - PowerPoint PPT Presentation
Trauma & Acute Care S urgery S ystems of Care S ymposium Travis Littman MD, F ACS April 18, 2015 Disclosures No Financial Disclosures or Conflicts of Interest S acred Heart Medical Center Oregon Trauma S ystem S HMC-Trauma
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S acred Heart Medical Center
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Oregon Trauma S ystem
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S HMC-Trauma
Emergency Depart ment Imaging Lab Blood bank OR ICU Inpat ient Wards Rehab
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Trauma PI/ QA process
Define t he Problem Collect Informat ion Analyze t he Informat ion Develop a solut ion Educat e t he t eam Measure Result s
- Nurse Coordinators
- Registrar’s
- TraumaOne
- TQIP
- CPG’s
- Protocols
- Monthly Dashboard
- Quarterly review
- Annual S
tate Report
- Grand Rounds
- Peer Review
- Mock Drills
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Trauma S ervices
- In House S
pecialties
- Emergency
- Trauma S
urgery
- Anesthesia
- Intensivists
- Ongoing QA and PI (Iterative process)
- Organized support services
- Coordination of multiple hospital departments
- Established Trauma Pathway
- Primary S
urvey
- Labs?
Imaging? )
- 2nd survey
- Int ervent ion?
- 3` survey
- Coordinated care and discharge
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Trauma – “ Golden Hour”
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Acute Care S urgery
- Team approach to Patient Care
- 24/ 7 Coverage and operative potential
- Multiple In-House S
pecialties
- S
imilar to Trauma Pathways
- Initial ACS
pathway
- Primary S
urvey
- Workup?
- 2nd survey
- Intervention
- 3` survey
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Acute Care S urgery
- Elderly population growing
- Growing list of comorbidities
- Expedited treatment to minimize effects on
physiology and morbidity
- Principles:
- Expeditious initial assessment
- End point-guided resuscitation
- Early intervention and definitive management
- Essential physiologic monitoring
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TRACS
Trauma ACS ICU
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S ystems of Care
PreHospital
EMS
Initial Evaluation
ED
Treatment
OR
Recovery
Ward
Rehabilitation
ORC
Reintegration
Home
Continuum
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Pre-Hospital Care
- Develop relationships with referring Hospitals
- ATAB
- Outreach
- Educational Programs (ATLS
, RTTDC)
- Develop relationships with EMS
- Regular feedback
- Discussions with Medical Directors
- Central LANE Medical Control
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Emergency Department Care
- Coordinate with ED for Trauma’s
- Attend all Full Trauma’s within 15 minutes of arrival
- Trauma Consults for Modified and walk-ins
- Transfers for multisystem inj ury
- General S
urgeons “ In House”
- Rapid evaluation of emergent general surgery
- Decreased time to disposition –
Ward/ OR
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Operating Room
- In House Anesthesia
- 24/ 7 In-House Tech & RN
- Trauma Room for Ortho and General S
urgery
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Hospital Care
- Coordinated team effort
- 3 full time S
urgeons with community surgeon backup
- Nurse Practitioner
- Multidisciplinary Rounds
- Full Trauma office
- Trauma Program Director
- Nurse Coordinators
- Registrars
- EMS
liaison/ Inj ury Prevention
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Rehab & Return Home
- S
BIRT screening, placement (S W)
- Physical and Occupational Therapy
- Rehab or ORC as needed
- Outpatient follow-up
- TRACS
Clinic weekly
- S
pecialty follow up as needed
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Current QA/ PI proj ects
- Blood and Resuscitation
- Fluids for resuscitation
- Early S
BFT for S BO
- (What else should we talk about?
)
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TRACS S ummary
- Improves Access to Care:
- Trauma and Emergency S
urgical Care for the Community 24/ 7
- Decrease Cost/ Better Outcomes:
- S
tandardized Clinical Practice Guidelines
- Robust Performance Improvement Program
- A TRACS