The right team at the right time – Multidisciplinary approach to multi-trauma patient with orthopedic injuries

Bach, John A.; Leskovan, John J.; Scharschmidt, Thomas J.; Boulger, Creagh; Papadimos, Thomas J.; Russell, Sarah; Bahner, David P.; Stawicki, Stanislaw P.

doi:10.4103/ijciis.ijciis_5_17

Cited by 44 publications

(17 citation statements)

References 43 publications

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“…Hence, as frequently argued, we believe that a multidisciplinary approach to multi-trauma patients can help optimize care, minimize morbidity and mortality, and ultimately provide a framework for accelerated post-injury rehabilitation [ 3 , 31 ]. In addition, reduction of LOS in rehabilitation center could lower costs as shown by Wu et al [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of an integrated 'fast track' rehabilitation service for multi-trauma patients: A non-randomized clinical trial in the Netherlands

et al. 2019

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BackgroundMultidisciplinary rehabilitation has been recommended for multi-trauma patients, but there is only low-quality evidence to support its use with these patients. This study examined whether a Supported Fast track multi-Trauma Rehabilitation Service (Fast Track) was cost-effective compared to conventional trauma rehabilitation service (Care As Usual) in patients with multi-trauma from a societal perspective with a one-year follow-up.MethodsAn economic evaluation alongside a prospective, multi-center, non-randomized, controlled clinical study, was conducted in the Netherlands. The primary outcome measure was the Functional Independence Measure (FIM). Generic Quality of Life and Quality Adjusted Life Years (QALYs) of the patients were derived using the Short-form 36 Health Status Questionnaire.Incremental Cost-Effectiveness Ratios (ICERs) were stated in terms of costs per unit of FIM improvement and costs per QALY. To investigate the uncertainty around the ICERs, non-parametric bootstrapping was used.ResultsIn total, 132 patients participated, 65 Fast Track patients and 67 Care As Usual patients. Mean total costs per person were €18,918 higher in the Fast Track group than in the Care As Usual group. Average incremental effects on the FIM were 3.7 points (in favor of the Fast Track group) and the incremental (extra) bootstrapped costs were €19,033, resulting in an ICER for cost per FIM improvement of €5,177. Care As Usual dominated Fast Track in cost per QALY as it gave both higher QALYs and lower costs. All sensitivity analyses attested to the robustness of our results.ConclusionsThis study demonstrated that a multidisciplinary rehabilitation program for multi-trauma patients according to the supported fast track principle is promising but cost-effectiveness evidence remains inconclusive. In terms of functional outcome, Fast Track was more expensive but yielded also more effects compared to the Care As Usual group. Looking at the costs per QALYs, unfavorable ICERs were found. Given the lack of a willingness-to-pay threshold for functional recovery and the relatively short time horizon, it is not possible to draw firm conclusions about the first.Trial registration(Current Controlled Trials register: ISRCTN68246661).

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of an integrated 'fast track' rehabilitation service for multi-trauma patients: A non-randomized clinical trial in the Netherlands

et al. 2019

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“…There are multiple types of approaches to the face, which will depend on the affected area, fractured bones and affected sinuses. [ 12 ]…”

Section: Experimental Design Materials and Methodsmentioning

confidence: 99%

Transoral approach in facial penetrating trauma - importance of multidisciplinary management and nutritional support a case report

Cardenas

García

García³

et al. 2021

Trauma Case Reports

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The high incidence and prevalence of facial trauma makes it important to consider related injuries and possible complications that may arise as a result. Penetrating trauma to the face, although not common, requires a surgeon with knowledge of the anatomy and physiology of the injured area and injury patterns. We present a case of penetrating trauma to the face that was caused by a blunt object (stake) resulting from the felling of a palm tree. We describe the transoral management that was performed and the multidisciplinary support that allowed optimal management of the injury without complications, including functional or aesthetic sequelae.

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“…The presence of a trauma team has been shown to reduce time to diagnostic procedures (eg, computed tomography scanning), time to operating room (OR), ED length of stay (LOS), and preventable deaths in severely injured children, 6 and the incidence of delayed diagnoses of injury, 7 by improving the coordination of care 6 . Nevertheless, gaps in care delivery are common, particularly for patients with multiple injuries requiring care from multiple specialty services 8–10 . Individual specialties tend to operate in silos, and transitions between care teams are often fraught with disruptions 11 .…”

Section: Background and Significancementioning

confidence: 99%

Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data

Durojaiye

Levin

Toerper

et al. 2019

Journal of the American Medical Informatics Association

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Objectives The study sought to identify collaborative electronic health record (EHR) usage patterns for pediatric trauma patients and determine how the usage patterns are related to patient outcomes. Materials and Methods A process mining–based network analysis was applied to EHR metadata and trauma registry data for a cohort of pediatric trauma patients with minor injuries at a Level I pediatric trauma center. The EHR metadata were processed into an event log that was segmented based on gaps in the temporal continuity of events. A usage pattern was constructed for each encounter by creating edges among functional roles that were captured within the same event log segment. These patterns were classified into groups using graph kernel and unsupervised spectral clustering methods. Demographics, clinical and network characteristics, and emergency department (ED) length of stay (LOS) of the groups were compared. Results Three distinct usage patterns that differed by network density were discovered: fully connected (clique), partially connected, and disconnected (isolated). Compared with the fully connected pattern, encounters with the partially connected pattern had an adjusted median ED LOS that was significantly longer (242.6 [95% confidence interval, 236.9–246.0] minutes vs 295.2 [95% confidence, 289.2–297.8] minutes), more frequently seen among day shift and weekday arrivals, and involved otolaryngology, ophthalmology services, and child life specialists. Discussion The clique-like usage pattern was associated with decreased ED LOS for the study cohort, suggesting greater degree of collaboration resulted in shorter stay. Conclusions Further investigation to understand and address causal factors can lead to improvement in multidisciplinary collaboration.

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The right team at the right time – Multidisciplinary approach to multi-trauma patient with orthopedic injuries

Cited by 44 publications

References 43 publications

Cost-effectiveness of an integrated 'fast track' rehabilitation service for multi-trauma patients: A non-randomized clinical trial in the Netherlands

Cost-effectiveness of an integrated 'fast track' rehabilitation service for multi-trauma patients: A non-randomized clinical trial in the Netherlands

Transoral approach in facial penetrating trauma - importance of multidisciplinary management and nutritional support a case report

Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data

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