Multidisciplinary Patient Management Improves Mortality in Geriatric Trauma Patients

2019 ◽  
Vol 85 (2) ◽  
pp. 230-233 ◽  
Author(s):  
Joseph Losh ◽  
Thomas K. Duncan ◽  
Graal Diaz ◽  
Hyesun Lee ◽  
Javier Romero
Keyword(s):  
Quality Improvement ◽  
Medical Center ◽  
Injured Patient ◽  
Primary Objective ◽  
Quality Improvement Program ◽  
Geriatric Trauma ◽  
Collaborative Management ◽  
Trauma Patients ◽  
Improvement Program ◽  
Trauma Medicine

Improvement in the care of the traumatically injured patient should be a goal at all trauma centers. One purpose of the data generated by the Trauma Quality Improvement Program is to provide insight which will lead to quality improvement initiatives and to promote intrinsic improvement on a center by center basis. The primary objective of this study was to measure the efficacy of instituting a multidisciplinary Trauma Medicine (T-MED) program to improve geriatric mortality at Ventura County Medical Center (VCMC). Trauma Quality Improvement Program data at VCMC before October 2013 demonstrated poor performance in treating geriatric patients. To attempt to improve outcomes, a multidisciplinary T-MED program was instituted in October 2013, which included a mandatory consultation and collaborative management with hospitalist medicine physicians for all trauma patients 65 years of age or older. The T-MED program increased focus on preexisting conditions, medication management, and discharge planning, including rehabilitation and continuity of care. Institution of a T-MED program at VCMC resulted in significant improvement in mortality rates for geriatric trauma patients.

scholarly journals Clinical Benefits of Early Concurrent use of Cryoprecipitate and Plasma Compared with Plasma only in Bleeding Trauma Patients: Analysis of the Trauma Quality Improvement Program Database

2021 ◽  
Author(s):  
Akira Endo ◽  
Atsushi Senda ◽  
Yasuhiro Otomo ◽  
Raul Coimbra
Keyword(s):  
Quality Improvement ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Quality Improvement Program ◽  
Trauma Patients ◽  
Clotting Factors ◽  
Improvement Program ◽  
Packed Red Blood Cells ◽  
Concurrent Use ◽  
Significant Difference

Abstract Background:The effectiveness of cryoprecipitate in trauma has not been well-established. In addition, the benefits of cryoprecipitate might have been overestimated in previous studies since the difference in the total amount of administered clotting factors was not considered. This study aimed to evaluate the benefits of the concurrent use of cryoprecipitate in combination with fresh frozen plasma (FFP) during the resuscitation of bleeding trauma patients.Methods: A retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database was conducted. Patients who received ≥4 units of packed red blood cells within the first 4 hours after arrival to the emergency department (ED) were dichotomized according to whether cryoprecipitate was used. The outcomes (primary: in-hospital mortality; secondary: 24-h mortality and incidence of complications) were compared using propensity score-matching analysis, in which the amount of total administered clotting factors was balanced.Results: A total of 19,008 patients (Cryo+FFP group: 3825; FFP only group: 15,183) were eligible for analysis, of whom 3103 propensity score-matched pairs were generated. Significantly lower in-hospital mortality (1217 [39.2%] patients in the Cryo+FFP group vs. 1295 [41.7%] in the FFP only group; odds ratio [OR], 0.90; 95% CI, 0.81-1.00) and 24-h mortality (735 [23.7%] vs. 886 [28.6%]; OR, 0.78; 95% CI, 0.69-0.87) were observed in the Cryo+FFP group than in the FFP only group; no significant difference was observed in the incidence of complications. Conclusions: Cryoprecipitate use combined with FFP was significantly associated with reduced mortality in bleeding trauma patients after adjustments were made for the dose of administered clotting factors. Future randomized controlled trials are warranted to confirm our results.

scholarly journals Improving survival after an emergency resuscitative thoracotomy: a 5-year review of the Trauma Quality Improvement Program

2018 ◽  
Vol 3 (1) ◽  
pp. e000201 ◽  
Author(s):  
Bellal Joseph ◽  
Muhammad Khan ◽  
Faisal Jehan ◽  
Rifat Latifi ◽  
Peter Rhee
Keyword(s):  
Quality Improvement ◽  
Survival Rate ◽  
Survival Rates ◽  
Quality Improvement Program ◽  
Trauma Patients ◽  
Improvement Program ◽  
Level Of Evidence ◽  
Resuscitative Thoracotomy ◽  
Program Outcome ◽  
Major Injury

BackgroundAdvancement in trauma care has led to the evolution of emergency resuscitative thoracotomy (ERT) for the revival of trauma patients. We now have more precise understanding of selecting suitable patients for achieving optimal outcomes. The aim of our study was to analyze the utilization and survival trends during the past 5 years, as well as factors that influence survival after ERT.MethodsA 5-year (2010-2014) analysis of all trauma patients ≥18 years who underwent ERT in the American College of Surgeons Trauma Quality Improvement Program. Outcome measures were utilization rates and survival trends after ERT during the 5-year period. Regression analysis was performed.Results2229 patients underwent ERT, mean age was 37±17 years, 81% were male. Overall 56% patients had penetrating mechanism, location of major injury was thorax in 48, and 71% had signs of life (SOL) on arrival. The overall survival rate was 9.6%. From 2010–2014 ERT utilization has decreased from 331/100 000 to 243/100 000 trauma admissions (p=0.002) and the survival rate has improved from 7.9% to 11.3% (p<0.001). On regression, the independent predictors of survival were penetrating mechanism, age<60 years, SOL on arrival, no prehospital CPR and ISS. No patient aged >60 years with a blunt mechanism of injury (MOI) survived, and there were no survivors above the age of 70 years, regardless of injury mechanism.DiscussionUtilization of ERT has been decreased during the study period along with improved survival rates. The results of our study demonstrate that performing ERT on patients aged >60 years with a blunt MOI or on any patient aged ≥70 years, regardless of MOI, is futile and should be avoided.Level of evidenceLevel III, prognostic studies.

Quality Improvement on an Academic Autopsy Service

2001 ◽  
Vol 125 (2) ◽  
pp. 237-245 ◽  
Author(s):  
John H. Sinard ◽  
Deborah J. Blood
Keyword(s):  
Quality Improvement ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Physician Satisfaction ◽  
Quality Improvement Program ◽  
Autopsy Rate ◽  
Quality Of Data ◽  
Improvement Program

Abstract Context.—Autopsy rates continue to decline in the United States. Objective.—Although many of the causes of this decline are external to pathology departments, we hypothesized that intradepartmental efforts to improve the quality of the service we provide to our clinical colleagues could increase our autopsy rate. Method.—We developed a multifaceted quality improvement program for our autopsy service aimed at increasing the visibility of the service, improving the service's reporting, and increasing the amount and quality of data available from the service. Setting.—A large academic medical center that performs approximately 250 autopsies each year. Results.—After implementation of our quality improvement program, the decline in our autopsy rate has not only stopped, but rates have even begun to increase. Additionally, physician satisfaction surveys conducted before and after implementation of our quality improvement initiatives showed an across-the-board improvement in clinician perception of the service. Conclusion.—Pathologists can and should be proactive in addressing the declining autopsy rate, rather than viewing it as someone else's problem or hoping that someone else will protect this important quality assurance tool for medical care.

Upper Extremity Free Flap Transfers: An Analysis of the National Surgical Quality Improvement Program Database

2020 ◽  
Author(s):  
George A. Beyer ◽  
Karan Dua ◽  
Neil V. Shah ◽  
Joseph P. Scollan ◽  
Jared M. Newman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Upper Extremity ◽  
Free Flap ◽  
Quality Improvement Program ◽  
Readmission Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Reoperation Rates

Abstract Introduction We evaluated the demographics, flap types, and 30-day complication, readmission, and reoperation rates for upper extremity free flap transfers within the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods Upper extremity free flap transfer patients in the NSQIP from 2008 to 2016 were identified. Complications, reoperations, and readmissions were queried. Chi-squared tests evaluated differences in sex, race, and insurance. The types of procedures performed, complication frequencies, reoperation rates, and readmission rates were analyzed. Results One-hundred-eleven patients were selected (mean: 36.8 years). Most common upper extremity free flaps were muscle/myocutaneous (45.9%) and other vascularized bone grafts with microanastomosis (27.9%). Thirty-day complications among all patients included superficial site infections (2.7%), intraoperative transfusions (7.2%), pneumonia (0.9%), and deep venous thrombosis (0.9%). Thirty-day reoperation and readmission rates were 4.5% and 3.6%, respectively. The mean time from discharge to readmission was 12.5 days. Conclusion Upper extremity free flap transfers could be performed with a low rate of 30-day complications, reoperations, and readmissions.

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