From the Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC.
J Trauma Acute Care Surg. 2020 Jan;88(1):176-179. doi: 10.1097/TA.0000000000002494.
The aim of this study was to determine whether the implementation of a dedicated multiprofessional acute trauma health care (mPATH) team would decrease length of stay without adversely impacting outcomes of patients with severe traumatic brain and spinal cord injuries. The mPATH team was comprised of a physical, occupational, speech, and respiratory therapist, nurse navigator, social worker, advanced care provider, and physician who performed rounds on the subset of trauma patients with these injuries from the intensive care unit to discharge.
Following the formation and implementation of the mPATH team at our Level I trauma center, a retrospective cohort study was performed comparing patients in the year immediately prior to the introduction of the mPATH team (n = 60) to those in the first full year following implementation (n = 70). Demographics were collected for both groups. Inclusion criteria were Glasgow Coma Scale score less than 8 on postinjury Day 2, all paraplegic and quadriplegic patients, and patients older than 55 years with central cord syndrome who underwent tracheostomy. The primary endpoint was length of stay; secondary endpoints were time to tracheostomy, days to evaluation by occupational, physical, and speech therapy, 30-day readmission, and 30-day mortality.
The median time to evaluation by occupational, physical, and speech therapy was universally decreased. Injury Severity Score was 27 in both cohorts. Time to tracheostomy and length of stay were both decreased. Thirty-day readmission and mortality rates remained unchanged. A cost savings of US $11,238 per index hospitalization was observed.
In the year following the initiation of the mPATH team, we observed earlier time to occupational, physical, and speech therapist evaluation, decreased length of stay, and cost savings in severe traumatic brain and spinal cord injury patients requiring tracheostomy compared with our historical control. These benefits were observed without adversely impacting 30-day readmission or mortality.
Therapeutic/care management, Level III.
本研究旨在确定是否实施专门的多专业急性创伤保健（mPATH）团队会降低住院时间，而不会对严重创伤性脑和脊髓损伤患者的结局产生不利影响。mPATH 团队由物理治疗师、职业治疗师、言语治疗师、呼吸治疗师、护士导航员、社会工作者、高级护理人员和医师组成，他们负责对来自重症监护病房的创伤患者进行查房，这些患者有上述这些损伤。
在我们的一级创伤中心成立并实施 mPATH 团队后，我们进行了一项回顾性队列研究，比较了在引入 mPATH 团队的前一年（n=60）的患者与实施后的第一年（n=70）的患者。为两组患者收集了人口统计学资料。纳入标准为伤后第 2 天格拉斯哥昏迷量表评分小于 8，所有截瘫和四肢瘫患者，以及年龄大于 55 岁且有中央脊髓综合征的患者需行气管切开术。主要终点为住院时间；次要终点为气管切开时间、接受职业、物理和言语治疗评估的天数、30 天再入院率和 30 天死亡率。
接受职业、物理和言语治疗评估的中位时间普遍缩短。两个队列的损伤严重程度评分均为 27。气管切开时间和住院时间均缩短。30 天再入院率和死亡率保持不变。观察到每例住院索引的成本节省了 11238 美元。
在启动 mPATH 团队的一年后，我们观察到严重创伤性脑和脊髓损伤患者需要气管切开术的患者接受职业、物理和言语治疗师评估的时间更早，住院时间更短，并且节省了成本，与我们的历史对照相比。这些益处并未导致 30 天再入院率或死亡率增加。
治疗/护理管理，III 级。
