scholarly journals Evaluation of RFID Technology to Capture Surgeon Arrival Time to Meet American College of Surgeons Committee on Trauma Verification Guidelines

ACI Open ◽  
2019 ◽  
Vol 03 (01) ◽  
pp. e13-e17 ◽  
Author(s):  
Heather Lyu ◽  
Nicholas Faoro ◽  
Meghan McDonald ◽  
Molly Jarman ◽  
Kevin Kreitzman ◽  
...  
Keyword(s):  
Trauma Surgeon ◽  
Trauma Centers ◽  
Rfid Technology ◽  
Nursing Documentation ◽  
Improvement Project ◽  
Administrative Burden ◽  
Significant Difference ◽  
American College Of Surgeons ◽  
Level I ◽  
Trauma Activation

Background The presence of an attending surgeon at all highest-level trauma activations is a requirement for American College of Surgeons-Committee on Trauma (ACS-COT) verification for level I to III trauma centers. Programs must demonstrate compliance with this criterion at least 80% of the time. Documentation of compliance can increase administrative burden presenting an opportunity for automation. Objectives The aim of this quality improvement project was to compare surgeon arrival documentation rates obtained utilizing radio-frequency identification (RFID) technology with manual documentation. Methods This project was conducted at a single level-I trauma center. RFID badges were distributed to all trauma surgeons. Arrival times for surgeons using manual nursing documentation and RFID activation were collected from October 2017 through March 2018. Presence of appropriate documentation and attending arrival within 15 minutes of trauma activation were compared by documentation method: nursing manual documentation or RFID system. Results There were 98 code trauma activations included in the analysis over the 6-month period. Nursing documentation of trauma surgeon attendance occurred 83% of the time (n = 81), with 81% (n = 79) in compliance within 15 minutes of code trauma activation. RFID badges were activated 91% (n = 89) of the time, with 86% (n = 84) in compliance within 15 minutes. There was no statistically significant difference between the rates of nursing documentation and RFID badge activation. Conclusion RFID technology is a reliable, complementary method of documenting compliance for trauma surgeon attendance. Trauma centers searching for technological solutions to address compliance with ACS-COT guidelines and to reduce administrative burden may consider the use of RFID technology.

Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

2020 ◽  
Vol 86 (5) ◽  
pp. 467-475
Author(s):  
Sara Seegert ◽  
Roberta E. Redfern ◽  
Bethany Chapman ◽  
Daniel Benson
Keyword(s):  
Injury Severity ◽  
Trauma Centers ◽  
Activation Level ◽  
American College Of Surgeons ◽  
Before And After ◽  
Trauma Response ◽  
Level 1 ◽  
Transferred Patients ◽  
Trauma Activation ◽  
Level 1 Trauma Center

Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.

American College of Surgeons Level I trauma centers outcomes do not correlate with patients’ perception of hospital experience

2017 ◽  
Vol 82 (4) ◽  
pp. 722-727 ◽  
Author(s):  
Bellal Joseph ◽  
Asad Azim ◽  
Terence O’Keeffe ◽  
Kareem Ibraheem ◽  
Narong Kulvatunyou ◽  
...  
Keyword(s):  
Trauma Centers ◽  
Hospital Experience ◽  
American College Of Surgeons ◽  
Level I

Does Resident Trauma Exposure Affect Advanced Trauma Operative Management Course Experience?

2016 ◽  
Vol 82 (3) ◽  
pp. 212-215 ◽  
Author(s):  
Jody M. Kaban ◽  
Melvin E. Stone ◽  
Anand Dayama ◽  
Saman Safadjou ◽  
Srinivas H. Reddy ◽  
...  
Keyword(s):  
Self Efficacy ◽  
Trauma Exposure ◽  
Operative Management ◽  
Trauma Centers ◽  
Operative Trauma ◽  
Traumatic Injuries ◽  
Significant Difference ◽  
American College Of Surgeons ◽  
Course Experience ◽  
Different Levels

The Advanced Trauma Operative Management (ATOM) course is a simulation course adopted by the American College of Surgeons to teach operative management of primarily penetrating, traumatic injuries. Although it is clear that overall operative trauma exposure is decreasing, the educational benefit of ATOM for residents with different amounts of trauma exposure remains unclear. Our aim was to determine whether residents from trauma centers experienced less benefit from the ATOM course when compared with residents from nontrauma centers. We compared two groups of residents who take ATOM through our institutional course, those from trauma centers and those from nontrauma centers. ATOM pre- and postcourse evaluations of knowledge and self-efficacy were collected from October 2007 to June 2013. Overall residents from three institutions, two trauma centers (100 residents) and one nontrauma center (34 residents), were included in the study. All resident groups had statistically significant improvement in knowledge and self-efficacy after taking the ATOM course ( P < 0.0001). There was no statistically significant difference in improvement relative to each of the groups in the ATOM categories of knowledge and self-efficacy. Our data show that residents with different levels of trauma exposure had similar pre- and postcourse scores as well as improvement in the ATOM evaluations. As operative trauma continues to decrease the ATOM course shows benefit for all residents regardless of the depth of their clinical trauma exposure in surgical residency.

Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma

2016 ◽  
Vol 82 (12) ◽  
pp. 1227-1231 ◽  
Author(s):  
Aaron M. Lewis ◽  
Salvador Sordo ◽  
Leonard J. Weireter ◽  
Michelle A. Price ◽  
Leopoldo Cancio ◽  
...  
Keyword(s):  
Public Transportation ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Incident Management ◽  
Trauma Centers ◽  
Select Group ◽  
Level Ii ◽  
American College Of Surgeons ◽  
Level I ◽  
Trauma Surgeons

Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals’ and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.

Are All Level I Trauma Centers Created Equal? A Comparison of American College of Surgeons and State-Verified Centers

2011 ◽  
Vol 77 (10) ◽  
pp. 1334-1336 ◽  
Author(s):  
Jennifer Smith ◽  
David Plurad ◽  
Kenji Inaba ◽  
Peep Talving ◽  
Lydia Lam ◽  
...  
Keyword(s):  
Injury Severity ◽  
Distress Syndrome ◽  
Data Bank ◽  
Trauma Centers ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
American College Of Surgeons ◽  
Outcome Differences ◽  
Level I ◽  
Facility Size

Scant literature investigates potential outcome differences between Level I trauma centers. We compared overall survival and survival after acute respiratory distress syndrome (ARDS) in patients admitted to American College of Surgeons (ACS)-verified versus state-verified Level I trauma centers. Using the National Trauma Data Bank Version 7.0, incident codes associated with admission to an ACS-verified facility were extracted and compared with the group admitted to state-verified centers. Overall, there were 382,801 (73.7%) patients admitted to ACS and 136,601 (26.3%) admitted to state centers. There was no adjusted survival advantage after admission to either type (4.9% for ACS vs 4.8% for state centers; 1.014 [95% CI, 0.987 to 1.042], P = 0.311). However, in the 3,088 cases of ARDS, mortality for admission to the ACS centers was 20.3 per cent (451 of 2,220) versus 27.1 per cent (235 of 868) for state centers. Adjusting for injury severity and facility size, admission to an ACS center was associated with a significantly greater survival after ARDS (0.75 [0.654 to 0.860]; P < 0.001). Level I verification does not necessarily imply similar outcomes in all subgroups. Federal oversight may become necessary to ensure uniformity of care, maximizing outcomes across all United States trauma systems. Further study is needed.

The Impact of American College of Surgeons Trauma Center Designation and Outcomes after Early Thoracotomy: A National Trauma Databank Analysis

2012 ◽  
Vol 78 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Marko Bukur ◽  
Bernardino Castelo Branco ◽  
Kenji Inaba ◽  
Ramon Cestero ◽  
Leslie Kobayashi ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Trauma Patients ◽  
National Trauma ◽  
Level Ii ◽  
Pressure Time ◽  
Significant Difference ◽  
American College Of Surgeons ◽  
Level I ◽  
The Impact

Trauma centers are designated by the American College of Surgeons (ACS) into four different levels based on resources, volume, and scientific and educational commitment. The purpose of this study was to evaluate the relationship between ACS center designation and outcomes after early thoracotomy for trauma. The National Trauma Databank (v. 7.0) was used to identify all patients who required early thoracotomy. Demographics, clinical data, and outcomes were extracted. Patients were categorized according to ACS trauma center designation. Multivariate logistic regression was used to evaluate the impact of ACS trauma center designation on mortality. From 2002 to 2006, 1834 (77.4%) patients were admitted to a Level I ACS verified trauma center, 474 (20.0%) to a Level II, and 59 (3.6%) to a Level III/IV facility. After adjusting for differences between the groups, there were no significant differences in mortality (overall: 53.3% for Level I, 63.1% for Level II, and 52.5% for Level III/IV, adjusted P = 0.417; or for patients arriving in cardiac arrest: 74.9% vs 87.1% vs 85.0%, P = 0.261). Subgroup analysis did not show any significant difference in survival irrespective of mechanism of injury. Glasgow Coma Scale score # 8, Injury Severity Score >16, no admission systolic blood pressure, time from admission to thoracotomy, and nonteaching hospitals were found to be independent predictors of death. For trauma patients who have sustained injuries requiring early thoracotomy, ACS trauma center designation did not significantly impact mortality. Nonteaching institutions however, were independently associated with poorer outcomes after early thoracotomy. These findings may have important implications in educational commitment of institutions. Further prospective evaluation of these findings is warranted.

Injury and Mortality Profiles in Level II and III Trauma Centers

2021 ◽  
pp. 000313482096629
Author(s):  
Ali Farhat ◽  
Areg Grigorian ◽  
Ahmed Farhat ◽  
Theresa L. Chin ◽  
Megan Donnelly ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Injury Severity ◽  
Trauma Centers ◽  
Median Length ◽  
Improvement Program ◽  
Level Ii ◽  
Risk Of Mortality ◽  
Severity Scores ◽  
American College Of Surgeons ◽  
Level I

Background While the benefit of admission to trauma centers compared to non-trauma centers is well-documented and differences in outcomes between Level-I and Level-II trauma centers are well-studied, data on the differences in outcomes between Level-II trauma centers (L2TCs) and Level-III trauma centers (L3TCs) are scarce. Objectives We sought to compare mortality risk between patients admitted to L2TCs and L3TCs, hypothesizing no difference in mortality risk for patients treated at L3TCs compared to L2TCs. Methods A retrospective analysis of the 2016 Trauma Quality Improvement Program (TQIP) database was performed. Patients aged 18+ years were divided into 2 groups, those treated at American College of Surgeons (ACS) verified L2TCs and L3TCs. Results From 74,486 patients included in this study, 74,187 (99.6%) were treated at L2TCs and 299 (.4%) at L3TCs. Both groups had similar median injury severity scores (ISSs) (10 vs 10, P < .001); however, L2TCs had a higher mean ISS (14.6 vs 11.9). There was a higher mortality rate for L2TC patients (6.0% vs 1.7%, P = .002) but no difference in associated risk of mortality between the 2 groups (OR .46, CI .14-1.50, P = .199) after adjusting predictors of mortality. L2TC patients had a longer median length of stay (5.0 vs 3.5 days, P < .001). There was no difference in other outcomes including myocardial infarction (MI) and cerebrovascular accident (CVA) ( P > .05). Discussion Patients treated at L2TCs had a longer LOS compared to L3TCs. However, after controlling for covariates, there was no difference in associated mortality risk between L2TC and L3TC patients.

scholarly journals A Survey of Residency Directors in Academic Trauma Centers for Policies on Airway Management in The Trauma Ward

2021 ◽  
Author(s):  
George Tewfik ◽  
Michal Gajewski ◽  
Jena Salem ◽  
Neil Borad ◽  
Michael Zales ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Airway Management ◽  
Difficult Airway ◽  
Improve Patient Care ◽  
The United States ◽  
Trauma Centers ◽  
Difficult Airways ◽  
Level I ◽  
Trauma Activation ◽  
Trauma Bay

Abstract Background Despite its presence as a critical procedure in the trauma setting, airway management is not performed uniformly, varying between institutions, particularly with personnel involved in decision-making. Past literature has noted a trend in which emergency medicine physicians assumed greater responsibility for primary management of airways in the trauma ward. In addition, many institutions have adopted tiered activation systems for traumas in order to improve patient care, deploying resources more effectively. In this study, a survey of residency directors was deployed to assess trends in airway management. Methods A validated survey was distributed to residency directors in anesthesiology, general surgery and emergency medicine in 190 Level I trauma centers in the United States. Questions assessed personnel management, complication tracking and difficult airway prediction factors, amongst other considerations for airway management in the trauma bay. Results Respondents completed the survey at a rate of 23.8% of those solicited. A majority of respondents indicated that emergency medicine physicians are primary airway managers in the trauma bay and that their institutions utilize tiered trauma activation systems at 77.4% and 95.6% respectively. Anesthesia providers were immediately available in 81% of respondent institutions with inconclusive data regarding protocols for delineating anesthesia involvement in difficult airways. More than a third of respondents indicated their institution either does not track airway complications or they did not know if complications were tracked. Finally, nine different criteria were used in varying degrees by respondents’ institutions to predict the presence of a difficult airway, including such factors as head/face trauma, airway fluid and obesity. Conclusion The trend towards airway management by emergency medicine physicians in the trauma bay continues, with anesthesia personnel available in many situations to assist in complicated patients. Complication tracking for airway management remains inconsistent, as does the criteria for prediction of the presence of difficult airways.

scholarly journals Impact of shelter-in-place order for COVID-19 on trauma activations: Santa Clara County, California, March 2020

2020 ◽  
Vol 5 (1) ◽  
pp. e000505 ◽  
Author(s):  
Joseph D Forrester ◽  
Raymond Liou ◽  
Lisa M Knowlton ◽  
Ronald M Jou ◽  
David A Spain
Keyword(s):  
Hospital Admissions ◽  
Traumatic Injury ◽  
Virus Transmission ◽  
Trauma Centers ◽  
Trauma Registries ◽  
Santa Clara County ◽  
Time Period ◽  
American College Of Surgeons ◽  
The Usa ◽  
Trauma Activation

IntroductionThe shelter-in-place order for Santa Clara County, California on 16 March was the first of its kind in the USA. It was unknown what impact this order would have on trauma activations.MethodsWe performed a retrospective analysis of institutional trauma registries among the two American College of Surgeons Level 1 trauma centers serving Santa Clara County, California. Trauma activation volumes at the trauma centers from January to March 2020 were compared with month-matched historical cohorts from 2018 to 2019.ResultsOnly 81 (3%) patients were trauma activations at the trauma centers in the 15 days after the shelter-in-place order went into effect on 16 March 2020, compared with 389 activations during the same time period in 2018 and 2019 (p<0.0001). There were no other statistically significant changes to the epidemiology of trauma activations. Only one trauma activation had a positive COVID-19 test.DiscussionOverall trauma activations decreased 4.8-fold after the shelter-in-place order went into effect in Santa Clara County on 16 March 2020, with no other effect on the epidemiology of persons presenting after traumatic injury.ConclusionShelter-in-place orders may reduce strain on healthcare systems by diminishing hospital admissions from trauma, in addition to reducing virus transmission.

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