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Trauma Site Visits

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

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  1. Trauma Site Visits Wayne Street RN Meeting Name Here And Date Here City – Location Identity

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. PIPS • Individual Counseling • Conversation or a letter ( see example ) • MM presentation and Article Type the footnote/source in this space

  14. 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

  15. 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

  16. 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

  17. 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

  18. Title for ChartSubtitle for Chart East West North % Type the footnote/source in this space

  19. Title for ChartSubtitle for Chart Type the footnote/source in this space

  20. Title for ChartSubtitle for Chart East West North % Type the footnote/source in this space

  21. Title for ChartSubtitle for Chart East West North % Years Type the footnote/source in this space

  22. Title for TableSubtitle for Table Type the footnote/source in this space

  23. Title for Organizational ChartSubtitle for Organization Chart Type the footnote/source in this space

  24. Mayo ClinicLocations

  25. Questions & Discussion

  26. Presentation Grid System (4:3 Ratio)

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