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trauma, emergency, critical care, quality assurance, quality, performance, improvement

Robert G Sawyer, Carlos A Tache Leon
Surgical and trauma intensive care units provide the facilities, resources, and personnel needed to care for patients who have been severely injured, present with acute surgical emergencies, require prolonged and complex elective surgical procedures, or have severe underlying medical conditions. Correcting the immediately evident physiologic derangement is only the first step in the care of these patients, because in many cases their prognosis and ultimate outcome will depend on whether additional insults accrued during their intensive care unit and hospital stay will prevent them from a full recovery...
September 2010: Critical Care Medicine
Timothy C Nunez, Pampee P Young, John B Holcomb, Bryan A Cotton
The majority of trauma patients (>90%) do not require any blood product transfusion and their mortality is <1%. However, 3% to 5% of civilian trauma patients will receive a massive transfusion (MT), defined as >10 units of packed red blood cells (PRBC) in 24 hours. In addition, more than 25% of these patients will arrive to emergency departments with evidence of trauma-associated coagulopathy. With this combination of massive blood loss and coagulopathy, it has become increasingly more common to transfuse early the trauma patients and with a combination of PRBC, plasma, and platelets...
June 2010: Journal of Trauma
Colin F Mackenzie, Peter Hu, Ayan Sen, Rick Dutton, Steve Seebode, Doug Floccare, Tom Scalea
Trauma Triage errors are frequent and costly. What happens in pre-hospital care remains anecdotal because of the dual responsibility of treatment (resuscitation and stabilization) and documentation in a time-critical environment. Continuous pre-hospital vital signs waveforms and numerical trends were automatically collected in our study. Abnormalities of pulse oximeter oxygen saturation (< 95%) and validated heart rate (> 100/min) showed better prediction of injury severity, need for immediate blood transfusion, intra-abdominal surgery, tracheal intubation and chest tube insertion than Trauma Registry data or Pre-hospital provider estimations...
November 6, 2008: AMIA ... Annual Symposium Proceedings
Elizabeth A Hunt, Margaret Heine, Susan M Hohenhaus, Xuemei Luo, Karen S Frush
OBJECTIVES: Trauma is the leading cause of death in children. The quality of initial medical care received by injured children contributes to outcomes. Our objective was to assess effectiveness of an educational intervention on performance of emergency department (ED) teams during simulated pediatric trauma resuscitations. METHODS: A prospective, preinterventional and postinterventional study was performed on a random, convenience sample of 17% of EDs in North Carolina...
November 2007: Pediatric Emergency Care
P Weninger, H Trimmel, T Nau, S Aldrian, F König, V Vécsei
OBJECTIVE: The aim of this study was a retrospective analysis of polytraumatized patients who were treated by a helicopter emergency medical service (HEMS) crew. This study was performed to evaluate the level of prehospital care provided for severely injured patients. Special consideration was given to treatment strategies of specific injuries which led to multiple injuries, defined as "polytrauma." METHODS: From September 1992 to April 2001 data of 386 patients treated in the Department of Traumatology of the University of Vienna were collected...
July 2005: Der Unfallchirurg
S Ruchholtz
The Trauma Registry of the German Society of Trauma Surgery represents a database for interhospital quality management in the field of treating severely injured patients. The presented study analyzes the Trauma Registry's impact on treatment quality in the participating hospitals. Since 1998 annual feedback on treatment quality was given to the hospitals of the Trauma Registry. Based on the data from 2001 (10,997 patients), 21 hospitals were studied that had provided data on more than 99 patients between 1999 and 2001...
October 2004: Der Unfallchirurg
C F Mackenzie, Y Xiao
Video recording is underused in improving patient safety and understanding performance shaping factors in patient care. We report our experience of using video recording techniques in a trauma centre, including how to gain cooperation of clinicians for video recording of their workplace performance, identify strengths of video compared with observation, and suggest processes for consent and maintenance of confidentiality of video records. Video records are a rich source of data for documenting clinician performance which reveal safety and systems issues not identified by observation...
December 2003: Quality & Safety in Health Care
Lynette A Scherer, Michael C Chang, J Wayne Meredith, Felix D Battistella
BACKGROUND: Performance review using videotapes is a strategy employed to improve future performance. We postulated that videotape review of trauma resuscitations would improve compliance with a treatment algorithm. METHODS: Trauma resuscitations were taped and reviewed during a 6-month period. For 3 months, team members were given verbal feedback regarding performance. During the next 3 months, new teams attended videotape reviews of their performance. Data on targeted behaviors were compared between the two groups...
June 2003: American Journal of Surgery
W F Dick, P J Baskett, C Grande, H Delooz, W Kloeck, C Lackner, M Lipp, W Mauritz, M Nerlich, J Nicholl, J Nolan, P Oakley, M Parr, A Seekamp, E Soreide, P A Steen, L van Camp, B Wolcke, D Yates
Basic and advanced care of trauma patients has always been an important aspect of prehospital and immediate in-hospital emergency medicine, involving a broad spectrum of disciplines, specialties and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources and operation. This complex background has, at least in part, hindered the development of a uniform pattern or set of criteria and definitions. This in turn has hitherto rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be readily evaluated or compared with acceptable validity...
2000: Acta Anaesthesiologica Belgica
A B Stundzia, C J Lumsden
INTRODUCTION: Little is known about how best to quantitatively measure air medical system performance and optimally manage air medical emergency medical services start-up, operation and growth. Moreover, very little has been done to produce and distribute relevant tools for these critical tasks. SETTING: A hypothetical system modeled on the Ontario, Canada, air ambulance operation. METHODS: A user-friendly, high-performance computer simulation tool for air ambulance system design, quality management and optimization was developed...
March 1994: Air Medical Journal
B Zintl, S Ruchholtz, D Nast-Kolb, C Waydhas, L Schweiberer
Quality management in early clinical care of patients with multiple injuries (description of actual process, identification of problems, implementation of quality improvement) is not possible without sufficient baseline data about the present situation of medical treatment. This study investigates whether the current documentation of treatment in the emergency room is appropriate to judge upon the quality of the process and to detect problems. In addition, a set of baseline data is presented. The performance in the treatment of 126 multiple injured patients was prospectively recorded from 1988 to 1993 and compared with an idealized process based upon an algorithm...
October 1997: Der Unfallchirurg
W F Dick
The current increase in the cost of health care must be considered as a severe threat to the prehospital emergency services system. Two examples have been selected--the patient with polytrauma and the patient in cardiac arrest--to demonstrate the dilemma between a need for objective data and the requirements of emergency patients. Study results obtained in trauma patients indicating that total prehospital time, including scene time, is correlated to patient outcome have led to the conclusion that at the scene treatment by emergency physicians may be dispensable...
January 1996: Der Anaesthesist
R Rosso, A Marx, I Castelli, A Bodoky, M Heberer, R Babst, N Renner, P Regazzoni
Undue delay between hospital admission and the beginning or urgent operative procedures is considered as a major mortality risk for polytraumatized patients in any trauma center. As part of a quality control study at our institution (Kantonsspital, University of Basel), the time spent for early resuscitation and diagnostic procedures was therefore prospectively recorded in 20 patients (mean age 38 years) with a mean ISS of 26.9 (range: 13 to 43). Time spent in the resuscitation room averaged 31.4 min (range: 10 to 50 min)...
September 1993: Helvetica Chirurgica Acta
P E Pepe, M K Copass, T H Joyce
Endotracheal intubation by emergency medical services (EMS) personnel in the prehospital setting decreases morbidity and helps to improve the outcome of critically ill patients, especially those with cardiac or respiratory arrest, multiple injuries, or severe head trauma. The endotracheal tube facilitates better oxygenation and ventilation because it enhances lung inflation and protects the lungs from aspiration. No other alternative modality is as efficacious. Compared to physicians in general, properly instructed, well-supervised paramedics can be trained to perform this procedure safely and more efficiently in the emergency setting...
November 1985: Annals of Emergency Medicine
D Lowe, R Pope, J Hedges
A prospective time-management analysis of trauma resuscitation (TR) of 431 patients arriving at a university trauma center documents timing and organization. Severity of injury, patient age, and potential airway injury were significant factors increasing the duration of TR up to a certain time (36 minutes). Moderately injured patients required less time (under 25 minutes). Patients needing emergent operations spent a minimal amount of time (20 minutes) in TR. Potential injuries involving the airway or cervical spine, or shock, added minutes...
May 1990: American Journal of Surgery
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