Coniglio Ray, McGraw Constance, Archuleta Mike, Bentler Heather, Keiter Leigh, Ramstetter Julie, Reis Elizabeth, Romans Cristi, Schell Rachael, Ross Kelli, Smith Rachel, Townsend Jodi, Orlando Alessandro, Mains Charles W
Trauma and Prehospital Services, Centura Health Trauma System, Centennial, Colorado (Messrs Coniglio, Archuleta, and Orlando, Mss McGraw, Bentler, Keiter, Ramstetter, Reis, Romans, Schell, Simms, Smith, and Townsend, and Dr Mains); Trauma Services Department, St Anthony Hospital, Lakewood, Colorado (Messrs Coniglio, Archuleta and Orlando, Ms McGraw, and Dr Mains); Trauma Research Department, Swedish Medical Center, Englewood, Colorado (Ms McGraw and Mr Orlando); and Trauma Services Department, Penrose St-Francis Hospital, Colorado Springs, Colorado (Ms McGraw, Mrs Coniglio, Archuleta, and Orlando, and Dr Mains).
J Trauma Nurs. 2018 Mar/Apr;25(2):139-145. doi: 10.1097/JTN.0000000000000337.
Colorado requires Level III and IV trauma centers to conduct a formal performance improvement program (PI), but provides limited support for program development. Trauma program managers and coordinators in rural facilities rarely have experience in the development or management of a PI program. As a result, rural trauma centers often face challenges in evaluating trauma outcomes adequately. Through a multidisciplinary outreach program, our Trauma System worked with a group of rural trauma centers to identify and define seven specific PI filters based on key program elements of rural trauma centers. This retrospective observational project sought to develop and examine these PI filters so as to enhance the review and evaluation of patient care. The project included 924 trauma patients from eight Level IV and one Level III trauma centers. Seven PI filters were retrospectively collected and analyzed by quarter in 2016: prehospital managed airway for patients with a Glasgow Coma Scale (GCS) score of less than 9; adherence to trauma team activation criteria; evidence of physician team leader presence within 20 min of activation; patient with a GCS score less than 9 in the emergency department (ED): intubated in less than 20 min; ED length of stay (LOS) less than 4 hr from patient arrival to transfer; adherence to admission criteria; documentation of GCS on arrival, discharge, or with change of status. There was a significantly increasing compliance trend toward appropriate documentation of GCS (p trend < .001) and a significantly decreasing compliance trend for ED LOS of less than 4 hr (p trend = .04). Moving forward, these data will be used to develop compliance thresholds, to identify areas for improvement, and create corrective action plans as necessary.
科罗拉多州要求三级和四级创伤中心开展正式的绩效改进项目（PI），但在项目开发方面提供的支持有限。农村医疗机构的创伤项目管理人员和协调员很少有PI项目开发或管理的经验。因此，农村创伤中心在充分评估创伤治疗结果方面常常面临挑战。通过一个多学科外展项目，我们的创伤系统与一组农村创伤中心合作，根据农村创伤中心的关键项目要素确定并定义了七个特定的PI筛选指标。这个回顾性观察项目旨在开发并检验这些PI筛选指标，以加强对患者护理的审查和评估。该项目纳入了来自八个四级创伤中心和一个三级创伤中心的924名创伤患者。2016年按季度回顾性收集并分析了七个PI筛选指标：格拉斯哥昏迷量表（GCS）评分低于9分的患者在院前进行气道管理；遵守创伤团队启动标准；启动后20分钟内有医师团队负责人在场的证据；急诊科（ED）中GCS评分低于9分的患者：在20分钟内进行插管；从患者到达至转运，ED住院时间（LOS）少于4小时；遵守入院标准；到达、出院或状态改变时GCS的记录。GCS适当记录的依从性呈显著上升趋势（p趋势<.001），而ED LOS少于4小时的依从性呈显著下降趋势（p趋势=.04）。展望未来，这些数据将用于制定依从性阈值，确定改进领域，并在必要时制定纠正行动计划。
