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Patient-centered checklist (PATCCH) communication protocol improves trauma patient satisfaction
Vol. 219, No. 4S, October 2014
CONCLUSIONS: Higher intracranial hemorrhage scores appear to be correlated with a greater systemic inflammatory response and likelihood of mortality in patients with traumatic ICH. Identifying trends in sports-related ocular injury among 10-19 year olds R Sterling Haring, BA, Joseph K Canner, MHS, Adil H Haider, MBBS, FACS, Eric B Schneider, PhD Johns Hopkins University School of Medicine, Baltimore, MD INTRODUCTION: Sports-related injuries have long been cited as one of the chief causes of ocular trauma in young people age 1019. Accordingly, sports regulatory bodies have increasingly supported the use of protective eyewear, with some going so far as to mandate its use in competition. We sought to identify the effect of such interventions on ocular trauma-related visits to Emergency Departments in the US. METHODS: Using data from the Nationwide Emergency Department Sample (NEDS), we identified visits among young people from 2006-2011. After selecting for visits with a diagnosis of sports-related ocular trauma, we analyzed trends related to incidence and subsequent inpatient hospitalization rates over time. RESULTS: From 2006-2011, the total number of adolescents age 10-19 visiting EDs with a sports-related ocular injury was 78,525. Overall, 78.2% of all ED visits and 83.3% of all subsequent hospital admissions occurred in males. U.S. population-based incidence rates over the period dropped 28.9% from 22.6 per 10,000 individuals age 10-19 in 2006 to 16.1 per 10,000 in 2011. Reductions occurred primarily for superficial injuries (69% reduction) and contusions (36% reduction), corresponding to a 76% reduction in the number of contusion-related hospitalizations. The majority (59.3%) of hospitalizations each year are due to blowout fractures of the orbit, which did not change over the period. CONCLUSIONS: Increased focus on eye safety in sports appears to have had a significant impact, although the majority of reductions were seen in injuries of mild-to-moderate severity. Further research is warranted to determine effective interventions for the prevention of more serious injuries. The effect of tissue damage volume on systemic inflammation and organ dysfunction Travis L Frantz, MS, Scott D Steenburg, MD, Greg E Gaski, MD, Timothy H Pohlman, MD, FACS, Todd O McKinley, MD, Robert L Reed, MD Indiana University School of Medicine, Indianapolis, IN INTRODUCTION: The Systemic Inflammatory Response Syndrome (SIRS) can lead to organ failure in multiply injured patients (MIPs). SIRS results from an immune response to endogenous molecules, Damage Associated Molecular Patterns (DAMPs) that are liberated from damaged tissue. It is not known how tissue damage affects the subsequent inflammatory response and organ
Scientific Papers: 2014 Clinical Congress
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dysfunction. This study quantifies how the volume of tissue damage affected the magnitude of inflammation and organ dysfunction in MIPs. METHODS: Data from 36 MIPs admitted to the ICU were used to calculate SIRS scores and Sequential Organ Functional Assessment scores. A novel radiographic index, the Tissue Damage Volume Score (TDVS), was calculated by making volumetric measurements of every injury detected on admission computed tomography scans and plain X-rays. Injury volumes were summed to generate a total body TDVS. Regression analyses evaluated correlations between TDVS and both inflammatory and organ dysfunction scores. RESULTS: Two distinct patient populations were identified comparing TDVS to organ dysfunction and SIRS. High-risk patients: SOFA ¼ 0.0043 TDVS + 3.72; Cumulative SIRS ¼ 0.031 TDVS + 22. Low-risk patients: SOFA ¼ 0.0006 TDVS + 2.68; Cumulative SIRS ¼ 0.014 TDVS - 6.1. SOFA vs TDVS slope was 7.2X higher in high-risk patients (p ¼ 0.0007) and SOFA vs Cumulative SIRS slope was 2.2X higher in high-risk patients (p ¼ 0.002) compared to low-risk patients. CONCLUSIONS: High-risk patients developed over twice the magnitude of inflammation per tissue damage volume compared to low-risk patients. The accentuated inflammatory response extrapolated into a 7X increase in the amount of organ dysfunction per tissue damage volume. Patient-centered checklist (PATCCH) communication protocol improves trauma patient satisfaction Aaron C Baker, MD, Jason B Young, MD, Bonnie McCracken, NP, Karen Kouretas, RN, Joseph M Galante, MD, FACS University of California-Davis Medical Center, Sacramento, CA INTRODUCTION: Withholding of hospital payments based on low patient satisfaction scores is imminent. High patient satisfaction is often difficult to achieve with trauma patients. Use of checklists has improved communication within operating rooms, and application of this model can potentially improve communication with trauma patients. We hypothesized that patient satisfaction may improve by promoting communication utilizing a checklist model. METHODS: A patient-centered checklist (PATCCH) was developed by a multidisciplinary team. Daily use guided nurse/physician communication to patients about disease/injury prognosis, expectations and care plan while promoting a coordinated interaction with nurses and physicians. Professional Research Consultants (PRC) Loyalty Scores, which surveys patient satisfaction after discharge, were assessed before and after PATCCH implementation. Percentage of “excellent” responses per month was used to compare satisfaction trends. RESULTS: From October 2011 to January 2012, 342 PATCCH guided interactions were performed, and most (65.8%) required 10-20 minutes to complete. The average score involving patients’
e54
Scientific Papers: 2014 Clinical Congress
satisfaction for the PRC categories significantly increased when compared to the average score of the previous 12 months. CONCLUSIONS: Implementation of a communication checklist protocol improves trauma patient satisfaction regarding physician care and nurse/physician communication. With the pending decrease in Medicare payments based on low satisfaction scores, PATCCH offers a model for physicians and nurses to use when communicating with trauma patients. Prehospital intubation adversely affects outcomes in patients receiving massive transfusion Joshua G Corsa, MD, Rodrigo F Alban, MD, FACS, John T Promes, MD, FACS Orlando Regional Medical Center, Orlando, FL INTRODUCTION: Prehospital intubation (PI) remains a controversial intervention by Emergency Medical Services (EMS) on trauma patients. It has been shown to adversely affect mortality in traumatic brain injury and animal models with hemorrhagic shock. We hypothesized that PI adversely affects outcomes in patients requiring massive transfusion (MT) in a level I trauma center. METHODS: We reviewed our trauma registry for all patients requiring MT (defined as total blood products > 12 units/first 24 hours) from 2009 to 2013. Patient demographics, injury and body region severity, prehospital airway interventions, scene and transport times, and outcomes were extracted from the database. A Mann-Whitney test was used for continuous variables, a Chisquare test for categorical variables, and logistic regression analysis was used to adjust for confounding variables. RESULTS: 193 patients received MT during the study period. PI was performed on 21 patients (11%) vs 172 patients (89%, no-PI group). Age, gender and initial blood pressure were similar amongst groups. ISS was 24.6 for PI vs 23.3 for no-PI, p¼NS. Mortality was worse for the PI group; hospital and ICU LOS was shorter. Scene and transport times were longer for the PI group: 18.3min vs 13.7 for no-PI group, p<0.05 and 17.8 min vs 13.3, p<0.05 respectively. A logistic regression model confirmed that PI was associated with increased mortality despite adjusting for age, ISS, blood units, transport and scene times: OR 7.5, 95% CI: 2.1-27.6, p<0.05.
J Am Coll Surg
CONCLUSIONS: Prehospital intubation was associated with increased mortality in trauma patients requiring massive transfusions. Other airway adjuncts and rapid transport should be encouraged in these patients. The G-60 trauma center: a future consideration? Marko Bukur, MD, FACS, Joe Catino, MD, FACS, Ivan Puente, MD, FACS, Robyn Farrington-Avila, RN, BSN, MBA-HCM, Margaret Crawford, RN, MSN, CCRN, CEN, Fahim Habib, MBBS, MPH, FACS Broward Health, Fort Lauderdale, FL and Tenet Healthcare Corporation, Dallas, TX INTRODUCTION: As the baby boomer population continues to age, more elderly patients will continue to present with injuries. Outcomes based studies have shown a positive correlation between volume and outcome. We sought to determine whether volume of elderly trauma patients treated impacted outcomes at two different Level I trauma centers. METHODS: This was a retrospective review of all elderly patients (> 60 years) admitted to two state-verified Level I trauma centers covered by one group of trauma surgeons over the past 5 years. The elderly trauma center (ETC) saw a greater proportion (52%) of elderly patients than the reference trauma center (30%, TC). Patients were stratified into ETC and TC groups. The primary outcomes were postinjury complications, mortality, as well as death after major complication (failure to rescue [FTR]). Multivariate regression was used to derive factors associated with the specified outcomes. RESULTS: ETC patients were older, had more severe head injuries (Head AIS 3), greater injury burden, and require ICU admission than those admitted to the TC. Need for operation, mechanism of injury, and co-morbidities were similar between the two groups. After adjusting for confounding factors trauma patients admitted to the ETC had significantly lower chance of developing a post-injury complication, FTR, and overall mortality. CONCLUSIONS: Elderly patients admitted to a Level I center seeing a higher proportion of older patients is associated with improved outcomes that extends beyond the treating surgeon alone. The exact etiology of these benefits should be determined for quality improvement in care the injured geriatric patient.
CONCLUSIONS: Higher intracranial hemorrhage scores appear to be correlated with a greater systemic inflammatory response and likelihood of mortality in patients with traumatic ICH. Identifying trends in sports-related ocular injury among 10-19 year olds R Sterling Haring, BA, Joseph K Canner, MHS, Adil H Haider, MBBS, FACS, Eric B Schneider, PhD Johns Hopkins University School of Medicine, Baltimore, MD INTRODUCTION: Sports-related injuries have long been cited as one of the chief causes of ocular trauma in young people age 1019. Accordingly, sports regulatory bodies have increasingly supported the use of protective eyewear, with some going so far as to mandate its use in competition. We sought to identify the effect of such interventions on ocular trauma-related visits to Emergency Departments in the US. METHODS: Using data from the Nationwide Emergency Department Sample (NEDS), we identified visits among young people from 2006-2011. After selecting for visits with a diagnosis of sports-related ocular trauma, we analyzed trends related to incidence and subsequent inpatient hospitalization rates over time. RESULTS: From 2006-2011, the total number of adolescents age 10-19 visiting EDs with a sports-related ocular injury was 78,525. Overall, 78.2% of all ED visits and 83.3% of all subsequent hospital admissions occurred in males. U.S. population-based incidence rates over the period dropped 28.9% from 22.6 per 10,000 individuals age 10-19 in 2006 to 16.1 per 10,000 in 2011. Reductions occurred primarily for superficial injuries (69% reduction) and contusions (36% reduction), corresponding to a 76% reduction in the number of contusion-related hospitalizations. The majority (59.3%) of hospitalizations each year are due to blowout fractures of the orbit, which did not change over the period. CONCLUSIONS: Increased focus on eye safety in sports appears to have had a significant impact, although the majority of reductions were seen in injuries of mild-to-moderate severity. Further research is warranted to determine effective interventions for the prevention of more serious injuries. The effect of tissue damage volume on systemic inflammation and organ dysfunction Travis L Frantz, MS, Scott D Steenburg, MD, Greg E Gaski, MD, Timothy H Pohlman, MD, FACS, Todd O McKinley, MD, Robert L Reed, MD Indiana University School of Medicine, Indianapolis, IN INTRODUCTION: The Systemic Inflammatory Response Syndrome (SIRS) can lead to organ failure in multiply injured patients (MIPs). SIRS results from an immune response to endogenous molecules, Damage Associated Molecular Patterns (DAMPs) that are liberated from damaged tissue. It is not known how tissue damage affects the subsequent inflammatory response and organ
Scientific Papers: 2014 Clinical Congress
e53
dysfunction. This study quantifies how the volume of tissue damage affected the magnitude of inflammation and organ dysfunction in MIPs. METHODS: Data from 36 MIPs admitted to the ICU were used to calculate SIRS scores and Sequential Organ Functional Assessment scores. A novel radiographic index, the Tissue Damage Volume Score (TDVS), was calculated by making volumetric measurements of every injury detected on admission computed tomography scans and plain X-rays. Injury volumes were summed to generate a total body TDVS. Regression analyses evaluated correlations between TDVS and both inflammatory and organ dysfunction scores. RESULTS: Two distinct patient populations were identified comparing TDVS to organ dysfunction and SIRS. High-risk patients: SOFA ¼ 0.0043 TDVS + 3.72; Cumulative SIRS ¼ 0.031 TDVS + 22. Low-risk patients: SOFA ¼ 0.0006 TDVS + 2.68; Cumulative SIRS ¼ 0.014 TDVS - 6.1. SOFA vs TDVS slope was 7.2X higher in high-risk patients (p ¼ 0.0007) and SOFA vs Cumulative SIRS slope was 2.2X higher in high-risk patients (p ¼ 0.002) compared to low-risk patients. CONCLUSIONS: High-risk patients developed over twice the magnitude of inflammation per tissue damage volume compared to low-risk patients. The accentuated inflammatory response extrapolated into a 7X increase in the amount of organ dysfunction per tissue damage volume. Patient-centered checklist (PATCCH) communication protocol improves trauma patient satisfaction Aaron C Baker, MD, Jason B Young, MD, Bonnie McCracken, NP, Karen Kouretas, RN, Joseph M Galante, MD, FACS University of California-Davis Medical Center, Sacramento, CA INTRODUCTION: Withholding of hospital payments based on low patient satisfaction scores is imminent. High patient satisfaction is often difficult to achieve with trauma patients. Use of checklists has improved communication within operating rooms, and application of this model can potentially improve communication with trauma patients. We hypothesized that patient satisfaction may improve by promoting communication utilizing a checklist model. METHODS: A patient-centered checklist (PATCCH) was developed by a multidisciplinary team. Daily use guided nurse/physician communication to patients about disease/injury prognosis, expectations and care plan while promoting a coordinated interaction with nurses and physicians. Professional Research Consultants (PRC) Loyalty Scores, which surveys patient satisfaction after discharge, were assessed before and after PATCCH implementation. Percentage of “excellent” responses per month was used to compare satisfaction trends. RESULTS: From October 2011 to January 2012, 342 PATCCH guided interactions were performed, and most (65.8%) required 10-20 minutes to complete. The average score involving patients’
e54
Scientific Papers: 2014 Clinical Congress
satisfaction for the PRC categories significantly increased when compared to the average score of the previous 12 months. CONCLUSIONS: Implementation of a communication checklist protocol improves trauma patient satisfaction regarding physician care and nurse/physician communication. With the pending decrease in Medicare payments based on low satisfaction scores, PATCCH offers a model for physicians and nurses to use when communicating with trauma patients. Prehospital intubation adversely affects outcomes in patients receiving massive transfusion Joshua G Corsa, MD, Rodrigo F Alban, MD, FACS, John T Promes, MD, FACS Orlando Regional Medical Center, Orlando, FL INTRODUCTION: Prehospital intubation (PI) remains a controversial intervention by Emergency Medical Services (EMS) on trauma patients. It has been shown to adversely affect mortality in traumatic brain injury and animal models with hemorrhagic shock. We hypothesized that PI adversely affects outcomes in patients requiring massive transfusion (MT) in a level I trauma center. METHODS: We reviewed our trauma registry for all patients requiring MT (defined as total blood products > 12 units/first 24 hours) from 2009 to 2013. Patient demographics, injury and body region severity, prehospital airway interventions, scene and transport times, and outcomes were extracted from the database. A Mann-Whitney test was used for continuous variables, a Chisquare test for categorical variables, and logistic regression analysis was used to adjust for confounding variables. RESULTS: 193 patients received MT during the study period. PI was performed on 21 patients (11%) vs 172 patients (89%, no-PI group). Age, gender and initial blood pressure were similar amongst groups. ISS was 24.6 for PI vs 23.3 for no-PI, p¼NS. Mortality was worse for the PI group; hospital and ICU LOS was shorter. Scene and transport times were longer for the PI group: 18.3min vs 13.7 for no-PI group, p<0.05 and 17.8 min vs 13.3, p<0.05 respectively. A logistic regression model confirmed that PI was associated with increased mortality despite adjusting for age, ISS, blood units, transport and scene times: OR 7.5, 95% CI: 2.1-27.6, p<0.05.
J Am Coll Surg
CONCLUSIONS: Prehospital intubation was associated with increased mortality in trauma patients requiring massive transfusions. Other airway adjuncts and rapid transport should be encouraged in these patients. The G-60 trauma center: a future consideration? Marko Bukur, MD, FACS, Joe Catino, MD, FACS, Ivan Puente, MD, FACS, Robyn Farrington-Avila, RN, BSN, MBA-HCM, Margaret Crawford, RN, MSN, CCRN, CEN, Fahim Habib, MBBS, MPH, FACS Broward Health, Fort Lauderdale, FL and Tenet Healthcare Corporation, Dallas, TX INTRODUCTION: As the baby boomer population continues to age, more elderly patients will continue to present with injuries. Outcomes based studies have shown a positive correlation between volume and outcome. We sought to determine whether volume of elderly trauma patients treated impacted outcomes at two different Level I trauma centers. METHODS: This was a retrospective review of all elderly patients (> 60 years) admitted to two state-verified Level I trauma centers covered by one group of trauma surgeons over the past 5 years. The elderly trauma center (ETC) saw a greater proportion (52%) of elderly patients than the reference trauma center (30%, TC). Patients were stratified into ETC and TC groups. The primary outcomes were postinjury complications, mortality, as well as death after major complication (failure to rescue [FTR]). Multivariate regression was used to derive factors associated with the specified outcomes. RESULTS: ETC patients were older, had more severe head injuries (Head AIS 3), greater injury burden, and require ICU admission than those admitted to the TC. Need for operation, mechanism of injury, and co-morbidities were similar between the two groups. After adjusting for confounding factors trauma patients admitted to the ETC had significantly lower chance of developing a post-injury complication, FTR, and overall mortality. CONCLUSIONS: Elderly patients admitted to a Level I center seeing a higher proportion of older patients is associated with improved outcomes that extends beyond the treating surgeon alone. The exact etiology of these benefits should be determined for quality improvement in care the injured geriatric patient.