scholarly journals 83 Closed Loop Audit Examining Documentation of Advanced Trauma and Life Support (ATLS) Secondary Survey in Polytrauma Cases at The Royal Infirmary of Edinburgh (RIE)

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Balfour ◽  
M Powell-Bowns ◽  
J Leow ◽  
C Arthur
Keyword(s):  
Life Support ◽  
Trauma Centre ◽  
Royal Infirmary ◽  
Local Policy ◽  
Post Intervention ◽  
Exact Test ◽  
Major Trauma Centre ◽  
Secondary Survey ◽  
Polytrauma Patients ◽  
Mean Time

Abstract Introduction Secondary survey is a key aspect of the ATLS guidelines in avoiding missed injuries in polytrauma patients. Aim: Evaluate the documentation of secondary survey in polytrauma cases admitted to the RIE A+E department. Method Standard audit protocol, retrospective data collection. Polytrauma patients and patients requiring Trauma CT were identified from the local trauma database. Primary outcome was successful completion and documentation of secondary survey. Cycle 1: All patients from 01/01/2015-01/09/2015. Local policy change included an A+E trauma booklet and policy of secondary survey on admission to Intensive Care. Cycle 2 was completed post-intervention for patients presenting between 11/01/2019-29/05/2019. Results Cycle 1 (N = 20, N Secondary survey documented=10, mean=50%). Mean time to secondary survey was 8 hours (range 3-49). Cycle 2 (N = 28, N Secondary survey documented=24, mean=87.5%). Mean time to a secondary survey was 4 hours 30 minutes (range=1-21hrs). Significant improvement in documentation (Fisher’s Exact Test, P = 0.017). Conclusions Implementation of the secondary survey protocol and trauma booklet significantly improved documentation of secondary survey in the polytrauma patient. Evidence also suggests improved time to secondary survey. However, documentation of secondary survey is not universal indicating further improvement is required in trauma care, as the RIE moves towards becoming a National Major Trauma Centre.

scholarly journals 1403 Leadership and Teamwork in The Major Trauma Service – Implementation of A New Approach to Secondary Surveys

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Jefferies ◽  
A Walls ◽  
P McKeag ◽  
R Houston ◽  
D Kealey
Keyword(s):  
Quality Improvement ◽  
Major Trauma ◽  
Trauma Centre ◽  
Research Network ◽  
Improvement Project ◽  
Orthopaedic Care ◽  
Trauma Service ◽  
Major Trauma Centre ◽  
Secondary Survey ◽  
Group 2

Abstract Aim Trauma Audit and Research Network (TARN) guidelines at a Major Trauma Centre in Northern Ireland state that all patients admitted with Major Trauma should have a secondary survey completed and documented within 24 hours of admission. Method All patients admitted with major trauma had their medical notes reviewed on discharge to look for evidence of a documented secondary survey. Two audit cycles were completed. The first from January 2018 to April 2018 (n = 38). Following a quality improvement project with specific interventions to improve compliance, including improved communication behaviours and the implementation of a revised trauma booklet, a second cycle was performed from October 2019 to January 2019 (n = 44) Results 58% of group 1 and 75% of group 2 had a documented secondary survey within 24 hours of admission. The interventions therefore resulted in an overall 17% increase in the number of secondary surveys completed within 24 hours. Patients admitted under Orthopaedic care had a significant improvement of 26% between cycles to 89% compliance. Cardiothoracics (33% to 40%), Neurosurgery (14% to 43%) and General Surgery (75% to 66%). Conclusions A quality improvement drive led by the Orthopaedic team involving the education of doctors, improving communication channels and the introduction of revised trauma documentation, resulted in a significant increase in the number of secondary surveys completed within 24 hours. Patients under the care of Orthopaedics were more likely to have a survey completed compared with other specialties. This highlights the need for more education and engagement of other specialities to increase compliance in secondary surveys.

1416 Trauma Laparotomy: Experience of a Newly Established Major Trauma Centre in Northern Ireland

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
F Lee ◽  
B Bashabayev ◽  
S Yoong
Keyword(s):  
Northern Ireland ◽  
Royal Victoria Hospital ◽  
Major Trauma ◽  
Trauma Centre ◽  
Trauma Network ◽  
Final Report ◽  
Major Trauma Centre ◽  
The Mean ◽  
One Year ◽  
Mean Time

Abstract Aim The aim of this study was to assess the perioperative pathway and outcomes of trauma laparotomy during a one-year period in a newly established Major Trauma Centre in Northern Ireland. Method Retrospective review of a trauma registry undertaken at the Belfast Royal Victoria Hospital between August 2019 and August 2020. Results During this one-year period, there were a total of 17 trauma laparotomies, with a female-to-male ratio of 6:11, and a mean age of 38.9 years. 15 of 17 cases were due to blunt trauma, with only 2 cases of penetrating trauma. Of trauma laparotomies, 8 were performed during day-time hours (0801-1800), 4 during evening-hours (1801-0000), and 5 during night-time hours (0001-0800). One perioperative death was recorded. The mean time to CT from arrival to ED was 34 minutes (national target of 30 minutes). The mean time until final report was 477 minutes (national target of < 24 hours). The decision to proceed to trauma laparotomy was made prior to the final report in 9 cases. The mean length of inpatient stay for trauma laparotomy patients was 23.3 days, with a mean of 8.9 days spent in critical care. Conclusions This review provides an overview of provision of care for patients who underwent trauma laparotomies in Royal Victoria Hospital MTC and identifies areas for improvement. We plan to prospectively review outcomes following the opening of the Major Trauma Ward on 7th September 2020 and the implementation of the Northern Ireland Major Trauma Network Bypass protocol on 26th October 2020.

P9 Impact of the relocation of a regional neuroscience service on major trauma patients

2019 ◽  
Vol 90 (3) ◽  
pp. e28.2-e28
Author(s):  
C Cabaret ◽  
M Nelson ◽  
M Foroughi
Keyword(s):  
Major Trauma ◽  
Strong Association ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Major Trauma Centre ◽  
Significant Difference ◽  
Ct Head ◽  
The Mean ◽  
The Impact ◽  
Mean Time

ObjectivesEvaluating the impact of relocating a regional neuroscience service on major trauma patients.DesignRetrospective analysis of prospectively collected data from 01/08/2013 to 31/07/2017.SubjectsPatients≥20 years with a TBI in the 2 years pre-relocation (cohort 1) and 2 years post-relocation (cohort 2).MethodsPatients were identified using the TARN registry. Comparison of the cohorts for demographics, type of neurosurgical input, site of first presentation and the times to first CT head and operation was conducted using cross-tabulation, percentages and statistical analysis (SPSS).Results30% of patients in cohort 1 (112 or 373) were admitted in neurosurgery. This increased to 40% of patients in cohort 2 (181 of 450). There was an increase in admissions for monitoring (70% vs 82%). Patients<60 years had a higher increment in admission (+16 points) than patients≥60 years (+8 points). A strong association was found between the relocation of the neuroscience service and the increase in proportion of patients first transported to the major trauma centre (63% vs 74%; p=0.037). There was a significant decrease in the mean time to operation (3.9 hour vs 2.0 hour; p=0.008) and no significant difference in the mean time to first CT head (1.3 hour vs 1.4 hour; p=0.689).ConclusionsThe relocation of neurosurgery has resulted in a significant increase in admission of patients<60 years with TBI in neurosurgery for monitoring, an increase in the proportion of patients first transported to the MTC and a reduction in the time to operation.

scholarly journals 171 Early senior assessment and access to CT in an emergency department

2020 ◽  
Vol 37 (12) ◽  
pp. 831.1-831
Author(s):  
Marta de Andres Crespo ◽  
Cheryl Zogg ◽  
Alex Novak ◽  
David Metcalfe
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Rat Model ◽  
Trauma Centre ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Electronic Health Record Data ◽  
Early Evaluation ◽  
Major Trauma Centre ◽  
Ct Head

Aims/Objectives/BackgroundThe Rapid Assessment and Treatment (RAT) model provides early senior assessment of undifferentiated ‘majors’ patients and has been proposed as a strategy for improving Emergency Department (ED) efficiency. One goal of RAT is to organise essential imaging at an earlier stage within the patient’s ED journey. This study aimed to identify any potential early impact of a RAT initiative on time to imaging for patients requiring CT head.Methods/DesignElectronic health record data were extracted for all patients that underwent head CT while in the ED over a 54-month period (48 months pre-intervention and 6 post-intervention) at a single Major Trauma Centre in England. Interrupted time series analysis was used to estimate any effect of RAT on time from ED arrival to imaging.Results/ConclusionsThere was a pre-existing gradual trend over the entire time series towards patients waiting less time for CT. Although time to CT appeared to increase when the RAT model was implemented, this change was small and not statistically significant (9.8 [95% CI -1.6 to 21.3] minutes). Following RAT implementation, the pre-existing trend towards quicker access to CT resumed but without any change in the slope of the line.This early evaluation did not identify an association between RAT implementation and speed of access to CT head. The system may mature over time and further evaluations will be necessary to identify delayed effects on access to imaging as well as other process measures intended to improve ED safety and efficiency.

scholarly journals P17: IMPROVING PLASTIC SURGERY OPERATION NOTE ACCESSABILITY AT A MAJOR TRAUMA CENTRE: A PROSPECTIVE COMPLETED AUDIT CYCLE

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
L Geoghegan ◽  
D Reissis
Keyword(s):  
Electronic Medical Records ◽  
Nursing Staff ◽  
Medical Records ◽  
Reconstructive Surgical Procedures ◽  
Trauma Centre ◽  
Post Intervention ◽  
Reminder System ◽  
Major Trauma Centre ◽  
Operation Note ◽  
Limit Access

Abstract Introduction Quality operation note documentation is essential for ensuring continuity of care amongst the multi-disciplinary team. The Royal College of Surgeons has published clear and succinct guidelines which outline the necessity for timely, accurate and accessible operation note documentation. Our department uses a bespoke electronic operation note template which is stored within a departmental database. The aim of this study was to evaluate the effect of online operation note guidance on the accessibility of operative documentation. Method A prospective audit of operation note documentation was conducted during two one-month periods in May and November 2018. All reconstructive surgical procedures, both trauma and elective, were included. A bespoke online reminder system was introduced to our electronic platform to encourage operation note upload onto electronic medical records. Result 224 cases (127 elective, 98 consultant-led) were included in the initial audit and 239 cases (173 elective, 131 consultant-led) in the post-intervention audit. 56% of operation notes were accessible to nursing staff pre-intervention. Post-intervention 83% of operation notes were accessible to nursing staff (p&lt; 0.05). No significant correlation was found between operation note accessibility and the type of case (elective vs emergency, r= -0.179), grade of operating surgeon (consultant vs registrar, r=0.259) and the number of operating surgeons (r=0.208). Conclusion This study highlights the importance of operation note accessibility to every member of the multidisciplinary team. A pop-up based intervention significantly improved accessibility of operation notes within electronic medical records although performance remains significantly below the expected standard. Take-home message The use of bespoke, online platforms may limit access to operation notes. A simple, pop-up based intervention significantly improves upload rate to electronic medical records however accessibility remains significantly below the expected standard.

scholarly journals 122 Penthrox: a service evaluation for methoxyflurane use in an emergency department setting

2020 ◽  
Vol 37 (12) ◽  
pp. 831.2-831
Author(s):  
Jack Ingham ◽  
Gareth Roberts
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Conscious Sedation ◽  
Statistical Significance ◽  
Service Evaluation ◽  
Trauma Centre ◽  
Royal Infirmary ◽  
Pain Scores ◽  
Major Trauma Centre ◽  
Fast Acting

Aims/Objectives/BackgroundIn Manchester Royal Infirmary, a major trauma centre, there are many patient presentations which require fast acting analgesia. Often these presentations, such as shoulder dislocations, require conscious sedation in order to be safely, effectively and humanely treated.Penthrox was introduced to the emergency department in December 2019. It was hoped that it would be used as an alternative to conscious sedation in patients requiring procedures. It was postulated that by having another analgesic method available, patients would have a greater likelihood of being discharged without the requirement for conscious sedation. This would therefore not require waiting for a Resus bed and therefore reduce length of stay in the department.Methods/DesignData was prospectively gathered for patients who received Penthrox in the months of December 2019 to July 2020 using a questionnaire that was filled in by clinicians.Audit forms were collated as well as attendance data (including length of stay) for shoulder dislocations Dec 19 - Feb 19.Pain scores were subjectively scored out of 10 and, using t-tests, compared for significance.Length of stay, checklist completion, progression to concious sedation, further pain relief requirements and indications were also analysed.Results/ConclusionsSubjectively reported pain scores were significantly reduced when comparing before and during procedure (<0.001, 95% CI of a reduction of 1.959 to 5.113) and also before and 10 mins after procedure (p= <0.001, 95% CI 3.96 to 6.33). The distributions of pain scores are demonstrated in the violin plot below.There was no significant association between checklist completion and progression to concious sedation.Difference between length of stay did not quite meet statistical significance (mean = 163.62 using penthrox, mean = 225 without penthrox. p = 0.06).There were no significant adverse events.In conclusion Penthrox is a safe and welcome addition to the ED formulary.

scholarly journals Is There a Role for Early Palliative Intervention in Frail Older Patients With a Neck of Femur Fracture?

2018 ◽  
Vol 9 ◽  
pp. 215145931878223 ◽  
Author(s):  
Andrew Davies ◽  
Thomas Tilston ◽  
Katherine Walsh ◽  
Michael Kelly
Keyword(s):  
Palliative Care ◽  
Femur Fracture ◽  
Trauma Centre ◽  
Care Plan ◽  
X Rays ◽  
Neck Of Femur ◽  
Early Palliative Care ◽  
Multidisciplinary Meeting ◽  
Major Trauma Centre ◽  
Neck Of Femur Fracture

Background: Patients with a neck of femur fracture have a high mortality rate. National outcomes have improved significantly as the management of this patient group is prioritized. In 2016, however, 4398 (6.7%) patients died within 30 days of admission. Objective: To investigate whether palliative care could be integrated early in the care plan for high-risk patients. Methods: All cases of inpatient mortality following neck of femur fracture at North Bristol Major Trauma Centre over a 24-month period were reviewed. A comprehensive assessment of care was performed from the emergency department until death. All investigations, interventions, and management decisions were recorded. A consensus decision regarding expected mortality was made for each case at a multidisciplinary meeting which included surgical, orthogeriatric, nursing, and anesthetic team input. Results: A total of 1033 patients were admitted following a neck of femur fracture. There were 74 inpatient deaths, and 82% were considered predictable at our multidisciplinary meeting. The mean length of stay was 18 days (range: 0-85, median 14). In 42% of cases, mortality was considered predictable on admission, and 40% were considered predictable following acute deterioration. These patients received on average 28 blood tests (range: 4-114) and 6.8 X-rays and computed tomographies (range: 2-20). Of this, 66% received end-of-life care; mean duration 2.3 days (range: 0-17). Conclusions: Mortality rates remain high in a subset of patients. This study demonstrates that intensive investigation and medical management frequently continues until death, including in patients with predictably poor outcomes. Early palliative care input has been integrated successfully into patient management in other specialties. We demonstrate that it is feasible to identify patients with hip fracture who may benefit from this expertise.

Laparotomy for Abdominal Stab Wound With Combined Omental and Organ Evisceration: 10-Year Experience From a Major Trauma Centre in South Africa

2021 ◽  
pp. 000313482110318
Author(s):  
Victor Kong ◽  
Cynthia Cheung ◽  
Nigel Rajaretnam ◽  
Rohit Sarvepalli ◽  
William Xu ◽  
...  
Keyword(s):  
South Africa ◽  
Small Bowel ◽  
Large Bowel ◽  
Major Trauma ◽  
Stab Wound ◽  
Length Of Hospital Stay ◽  
Trauma Centre ◽  
Major Trauma Centre ◽  
The Mean ◽  
Overall Mortality

Introduction Combined omental and organ evisceration following anterior abdominal stab wound (SW) is uncommon and there is a paucity of literature describing the management and spectrum of injuries encountered at laparotomy. Methods A retrospective study was undertaken on all patients who presented with anterior abdominal SW involving combined omental and organ evisceration who underwent laparotomy over a 10-year period from January 2008 to January 2018 at a major trauma centre in South Africa. Results A total of 61 patients were eligible for inclusion and all underwent laparotomy: 87% male, mean age: 29 years. Ninety-two percent (56/61) had a positive laparotomy whilst 8% (5/61) underwent a negative procedure. Of the 56 positive laparotomies, 91% (51/56) were considered therapeutic and 9% (5/56) were non-therapeutic. In addition to omental evisceration, 59% (36/61) had eviscerated small bowel, 28% (17/61) had eviscerated colon and 13% (8/61) had eviscerated stomach. A total of 92 organ injuries were identified. The most commonly injured organs were small bowel, large bowel and stomach. The overall complication rate was 11%. Twelve percent (7/61) required intensive care unit admission. The mean length of hospital stay was 9 days. The overall mortality rate for all 61 patients was 2%. Conclusions The presence of combined omental and organ evisceration following abdominal SW mandates laparotomy. The small bowel, large bowel and stomach were the most commonly injured organs in this setting.

342 Rib Fracture Scoring at The Royal Sussex County Hospital, A Major Trauma Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Harris ◽  
Z Mitha ◽  
D White ◽  
W Davies
Keyword(s):  
Scoring System ◽  
Multidisciplinary Care ◽  
Rib Fractures ◽  
Rib Fracture ◽  
County Hospital ◽  
Sample Population ◽  
Post Intervention ◽  
Sussex County ◽  
Chest Infection ◽  
Major Trauma Centre

Abstract Introduction In April 2017, The Royal Sussex County Hospital introduced rib fracture scoring to help guide the management of rib fractures. Rib fracture score = (number of fractures x number of sides) + age score1 In this study, we audit our adherence to the scoring system and compare our management of chest trauma before and after its implementation. Method All admissions with rib fractures between 1/10/2016- 28/02/2017 (N = 35) and 1/10/2019- 31/01/2020 (N = 41) were recorded. Electronic and written notes were used to retrospectively record multidisciplinary care involvement, analgesics, chest infection and death. Results The pre-intervention cohort had an average age of 55.1 years and rib score of 8.8. The post intervention cohort had an average age of 67.2 years and score of 11.3. Following implementation, 45% of patients had a rib score recorded. Post-intervention, anaesthetic involvement increased by 34.5% and 15.4% more patients received a regional block. Inpatient nights fell from 11.2 to 10.1, mortality rate from 7% to 4% but the incidence of chest infection remained similar. Conclusions The implementation of a rib fracture scoring system has led to greater multidisciplinary care and higher levels of pain management. A larger study is required to assess patient outcome given the change in sample population over time.

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