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Trauma Site Visits. Wayne Street RN. Meeting Name Here And Date Here. City – Location Identity. Objectives. Level III and Level VI trauma site visit The pre-meeting conference Facility Commitment The Tour PI and Chart review. Type the footnote/source in this space. Expectations.

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Trauma site visits

Trauma Site Visits

Wayne Street RN

Meeting Name Here

And Date Here

City – Location Identity


Objectives
Objectives

  • Level III and Level VI trauma site visit

    • The pre-meeting conference

    • Facility Commitment

    • The Tour

  • PI and Chart review

Type the footnote/source in this space


Expectations
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

Type the footnote/source in this space


Typical schedule
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 )

Type the footnote/source in this space


Meet and greet exit interview
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

Type the footnote/source in this space


The tour
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

Type the footnote/source in this space


The people team
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

Type the footnote/source in this space


Trauma pips
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?

  • Chart review – Deaths, ISS > 15, transfer outs

  • Registry Data

  • Meeting minutes; Systems – Peer review

  • Highlight loop closure

Type the footnote/source in this space


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

Type the footnote/source in this space


Pips tpm and tmd your gang decides
PIPS – TPM and TMD – Your Gang decides

  • • 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

  • • 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

  • • Patient transferred out >3 hours after ED arrival

  • • Interval of >8 hours between arrival and initiation of debridement of an open tibial fracture, excluding a low velocity gunshot wound

  • • Abdominal, thoracic, vascular, or cranial surgery performed >24 hours after arrival

  • • Trauma patient admitted to the hospital under care of admitting or attending physician who is not a surgeon and ISS >9

  • • Non-fixation of femoral diaphyseal fracture in adult trauma patient

  • • Any patient requiring reintubation of the airway within 48 hours of extubation

  • •Transfusion of > 4units PRBCs ro activation of Massive transfusion protocol ; Patients receiving Factor VIIa

  • • 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

Type the footnote/source in this space


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

Type the footnote/source in this space


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

Type the footnote/source in this space


PIPS

  • Individual Counseling

  • Conversation or a letter ( see example )

  • MM presentation and Article

Type the footnote/source in this space


Pips simple documentation
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

Type the footnote/source in this space


Exit interview
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

Type the footnote/source in this space


Closing
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

Type the footnote/source in this space


Title here subtitle here
Title Here Subtitle Here

  • Type your first bulleted point here

  • Type your second bulleted point here

    • First subpoint

    • Second subpoint

  • Type your third bulleted point here

  • Etc, etc, etc…

    • Etc, etc, etc…

Type the footnote/source in this space


Title for chart subtitle for chart
Title for ChartSubtitle for Chart

East

West

North

%

Type the footnote/source in this space


Title for chart subtitle for chart1
Title for ChartSubtitle for Chart

Type the footnote/source in this space


Title for chart subtitle for chart2
Title for ChartSubtitle for Chart

East

West

North

%

Type the footnote/source in this space


Title for chart subtitle for chart3
Title for ChartSubtitle for Chart

East

West

North

%

Years

Type the footnote/source in this space


Title for table subtitle for table
Title for TableSubtitle for Table

Type the footnote/source in this space


Title for organizational chart subtitle for organization chart
Title for Organizational ChartSubtitle for Organization Chart

Type the footnote/source in this space


Mayo clinic locations
Mayo ClinicLocations




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