It is recommended that healthcare providers should review their current equipment provision and approach to managing risks and injuries associated with patient handling activities in the context of this research evidence.
Simulation in surgery is becoming an important component of surgical education. Training on bench top models has been demonstrated to improve technical skills. The objective of our project was to create a vascular surgery simulation model. The simulation model consists of a platform, artificial blood reservoir, artificial blood, inflow and outflow limbs, electric motor, battery, pulse generator, and cryopreserved vessel. Three different vascular surgery simulation stations were created: carotid endarterectomy with shunting and patch angioplasty, arterial bypass, and arteriovenous graft formation. A scientific study involving surgical residents will need to be undertaken to determine whether this simulator has intermodal transferability.
Trauma patients report being unprepared for hospital discharge. The purpose of this study was to identify follow-up compliance rates at our trauma clinic and identify factors associated with trauma patients' adherence to follow-up appointment. We recruited patients 15 years and older who were discharged from the trauma service between December 2014 and August 2015. Demographic information and injury-related variables were obtained from the trauma registry for patients who attended their follow-up and those who did not attend. Follow-up appointment weather data were collected. All patients were surveyed regarding barriers to compliance. There was no difference in demographics, number of intensive care unit days, length of stay, or distance to the clinic. On days with rain or snow, patients were less likely to follow-up. Patients were more likely to follow-up on warmer days, and maximum daily air temperature was an independent predictor of follow-up compliance. Mechanism of injury and trauma activations were associated with higher follow-up compliance. Trauma patients are overall compliant with postdischarge follow-up appointments. There are no consistent factors related to trauma follow-up when compared with similar follow-up studies.
Traditional care of mild traumatic brain injury (MTBI) is to discharge patients from the emergency department (ED) if they have a Glasgow Coma Score (GCS) of 15 and a normal head computed tomography (CT) scan. However, this does not address short-term neurocognitive deficits. Our hypothesis is that a notable percentage of patients will need outpatient neurocognitive therapy despite a reassuring initial presentation. This is a retrospective review of patients with MTBI at an urban Level I trauma center. Inclusion criteria were a diagnosis of MTBI in patients 14 years old or older, GCS 15, negative head CT scan, a completed neurocognitive evaluation, blunt mechanism, and no confounding psychiatric comorbidities. Six thousand thirty-two patients were admitted over 18 months. Three hundred ninety-five patients met inclusion criteria. Average age was 38 years (range, 14 to 93 years), 64 per cent were male, and mean Injury Severity Score (ISS) was 8.1. Forty-one per cent were cleared for discharge without follow-up. Twenty-seven per cent required ongoing neurocognitive therapy. Three per cent were deemed unsafe for discharge home. Of the patients cleared for discharge, 88 per cent had positive/questionable loss of consciousness (LOC), whereas 81 per cent who required additional therapy had positive/questionable LOC ( P = 0.20). Age, gender, ISS, and alcohol use were compared between the groups and not found to be statistically different rendering them poor predictors for appropriate discharge from the ED. A surprisingly high percentage (27%) of patients who would have met traditional ED discharge criteria were found to have persistent deficits after neurocognitive testing and were referred for ongoing therapy. We provide evidence to suggest that we should take pause before discharging patients with MTBI without a cognitive evaluation.
The Functional Independence Measure (FIM) is used by rehabilitation professionals to access disability. The FIM score combines both motor and cognitive parameters to assess a patient's level of required assistance in performing activities of daily living (ADL). The geriatric trauma patient is becoming an increasingly important cohort for trauma services. FIM has been shown to predict discharge outcomes and those at high risk for falls. We hypothesized pretrauma FIM scores may predict survival in the geriatric trauma population. This was a retrospective study of patients 65 years and older that were admitted to our Level I trauma center from July 1, 2006 to July 1, 2012. A total 941 patients underwent stepwise regression to identify those factors predicting survival. Age, Injury Severity Score, revised trauma score, body mass index, and pretrauma FIM scores (12-point scale) were studied. The primary outcome was survival. Statistical significance reached at P value <0.05. Multiple logistic regression analysis was then performed. A total of 1315 patients were identified and complete data were available on 941 patients. Mean age was 78 (SD ± 8.2), mean Injury Severity Score was 13(SD ± 8.7), and mean body mass index was 26. Overall mortality was 11 per cent. The odds ratio of survival was 3.532 (95% confidence interval = 2.191–5.718) times greater for every 1-point increase in the preadmission FIM expression score. Glasgow Coma Scale, revised trauma score, gender, and pretrauma FIM expression scores were predictive of survival in the geriatric trauma patient. Pretrauma FIM expression can be used to predict survival in the elderly trauma victim. Further study is needed to establish the role of FIM as part of trauma scoring systems.
The American College of Surgeons Committee on Trauma requires physician-to-physician communication prior to interhospital transfer. This requirement can be difficult to achieve in high-volume trauma centers. This pilot project utilizes trauma advanced practice providers (APPs) as the primary communicator, in lieu of the trauma surgeon, prior to interhospital transfer. The hypothesis suggests that APPs can provide safe recommendations and accurately triage patients for the highest level trauma alert. From January to April 2018, a total of 1,145 patients were transferred to a Level I or Level II trauma center. All interhospital trauma transfers were dispatched through a designated transfer center APP (TCAPP). Descriptive statistics were used to describe the frequency of core TCAPP recommendations, including reversal agents for anticoagulants, antibiotics for open fractures, direct admission criteria, administration of blood products, and triaging to the highest level of trauma activation. TCAPP triage accuracy was analyzed and reported as percentages. Percentages are compared between independent groups using a chi-square test. Prior to implementation of the TCAPP role, provider-to-provider communication occurred in less than 1% of interhospital transfers; TCAPP-to-provider communication occurred 92% of the time (p < .001). During the study period, the TCAPP made 398 care-related recommendations. Three (<1%) TCAPP recommendations were deemed inappropriate. The TCAPP (89.7%) and physician (89.9%) triage accuracy was not significantly different (p = .43). Interhospital transfer communication and recommendations can be performed safely and accurately by a trauma trained APP.
Background: Mild traumatic brain injury (mTBI) remains a prevalent public health concern. Implementation of an mTBI guideline encouraged screening all patients at risk for mTBI, followed by outpatient follow-up in a “concussion clinic.” This resulted in an increase in inpatient concussion evaluations, followed by high-volume referral to the concussion clinic. This prompted the routine use of an outpatient mTBI symptom screening tool. The purpose of this quality improvement study was to analyze the characteristics of an mTBI population at outpatient follow-up and describe the clinicians' care recommendations as determined through the use of an mTBI symptom screening tool. Methods: This is a retrospective review of mTBI patients at a Level 1 trauma center. The study includes patients who completed a concussion screening in the outpatient setting over a 6-month period. Patients were included if older than 16 years, sustained blunt trauma, and had a formal neurocognitive evaluation by a certified speech therapist within 48 hr of initial injury. Results: Of the 247 patients included, 197 (79.8%) were referred to the concussion clinic, 33 (13.4%) had no further outpatient needs, and 17 (6.9%) were referred for outpatient neurocognitive rehabilitation. On follow-up, 97 patients were deemed to have no further postconcussion needs by the trauma nurse practitioner; 57 patients were cleared by the speech therapist. In total, 43 outpatient mTBI follow-up encounters resulted in referral for ongoing therapy. Conclusion: Routine screening for concussion symptoms and detailed clinical evaluation allows for prompt recognition of further posttraumatic mTBI needs.
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