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Nearly universally, trauma surgeons at Level I and Level II trauma centers must be at the bedside within 15 minutes of the patient’s arrival. For most, this means that they must take in-house call. This requirement has been on the books for decades. It’s just the way we do it. And that makes it fair … Continue reading In-House Trauma Surgeon Call – Worth It? →
Resuscitative thoracotomy is a (sometimes) life-saving procedure reserved for trauma patients in extremis. Thankfully, most trauma centers do very few of these a year. However, that makes it one of those “high severity – low frequency” procedures that generate many, many quality improvement problems. Many of these issues are due to operator unfamiliarity or equipment … Continue reading The…
I analyzed the first of two PI clock scenarios in my last post. They are not always as obvious as they seem. Now let’s look at the second case: A young male is involved in a motor vehicle crash and strikes his head. He enters your trauma center at exactly midnight as a trauma activation. … Continue reading When Does The PI Clock Start Ticking? The Answer, Part 2! →
In my last post, I presented two potential performance improvement (PI) cases. I asked for your input as to when the clock should actually start for the 4-hour craniotomy/craniectomy rule. Today, I’ll give you my answer to the first case. Let’s look at it again: A young male is involved in a motor vehicle crash … Continue reading When Does The PI Clock Start Ticking? The Answer, Part 1! →
This is a question that comes up frequently in trauma performance improvement (PI) programs. Several of the PI audit filters typically used at trauma centers include a time parameter. Some of these include: Craniotomy > 4 hrs Laparotomy > 4 hrs OR for open fracture > 8 hrs (although this is now outdated) OR for … Continue reading When Does The PI Clock Start Ticking? →
By now, most trauma program personnel understand the concept of undertriage. Undertriage occurs when an incoming trauma patient needs a level of care in the emergency department that they don’t get. It could happen if they meet any activation criterion and no activation is called, or if they meet the highest-level criteria and a secondary-level … Continue reading Undertriage And Timing Of Your…
The American College of Surgeons Committee on Trauma (ACS-COT) and all trauma center designating agencies stipulate an expected response time for the trauma surgeon to the highest-level activation. Nearly universally, the expected time is 15 minutes, although a few centers have actually reduced that short time frame. Let’s look at this a little more closely. … Continue reading Trauma Surgeon…
I’ve seen hospitals (and trauma programs) boast that their venous thromboembolism (VTE) rate is very low. The numbers they report to state agencies or TQIP may be fractions of a percent. But is it real? The main problem is a phenomenon called surveillance bias. This occurs when a condition appears more common in one group … Continue reading My VTE Rate Is Really Low! Are You So Sure…? →
Over the years, I’ve seen a number of trauma professionals, both surgeons and emergency physicians, order liver transaminases (SGOT, SGPT) and bilirubin in patients with liver laceration. I’ve never been clear on why, so I decided to check it out. As it turns out, this is another one of those “old habits die hard” phenomena. … Continue reading Liver Laceration And Liver Function Tests →
In my previous post, I stressed using a structured process to hand off information between the overnight trauma team and the incoming day providers. There is one more very important handoff that occurs in most centers as well: the afternoon handoff. This involves the transition between the day team, who received the morning report, and … Continue reading Trauma Service Best Practice: The Afternoon…