Ashley M. Hervey

Acceptability and implementation of debriefings after trauma resuscitation.

Postresuscitation debriefings allow team members to reflect on performance and discuss areas for improvement. Pre-/postsurveys of trauma team members (physicians, mid-level practitioners, technicians, pharmacists, and nurses) were administered to evaluate the acceptability of debriefings and self-perceptions after multidisciplinary trauma resuscitations. After a 3-month trial period, improvements were observed in perceptions of psychological and patient safety, role on team, team communication, and acceptability of the debriefing initiative. Regrouping for a debriefing requires organizational change, which may be more easily assimilated if team members recognize the potential for process improvement and feel confident about success.

Evaluating the quality of online information about concussions.

Objectives:Compare and assess information available on the Internet about the definition, symptoms, treatment, and return to play recommendations after a concussion. Methods:The top 10 websites generated by a Google search on the keyword “concussion” were evaluated by two independent researchers and three medical professionals for definition, signs, symptoms, home treatment, care-seeking advice, and return to play recommendations. The medical professionals also rated their willingness to recommend each website to patients. Results:Each website contained a general list of signs, symptoms, and home treatment. One website advised the use of ibuprofen, four advised against ibuprofen, and five made no medication recommendations. Nine websites contained guidance on seeking physician care, and eight recommended athletes not return to play until cleared by a healthcare professional. Conclusion:Nine of the websites contained information for each section evaluated; however, information was inconsistent. Healthcare providers should be aware of the variable quality of information available on the Internet and guide patients to more optimal resources.

Usability testing of a fall prevention toolkit.

ABSTRACTObjectives: This study sought to evaluate a fall prevention toolkit, determine its ease of use and user satisfaction, and determine the preferred venue of distribution.Methods: Three forms of assessment were used: focus groups, usability testing, and surveys. Focus group participants were recruited from four locations: two rural health clinics and two urban centers. Usability testing participants were recruited from two rural health clinics. Survey questions included self-reported prior falls, current fall prevention habits, reaction to the toolkit, and demographics.Results: Participants reported the toolkit was attractive, well-organized, and easy to use, but may contain too much information. Most participants admitted they would not actively use the toolkit on their own, but prefer having it introduced by a healthcare provider or in a social setting.Conclusions: Healthcare focuses on customer satisfaction; therefore, providers benefit from knowing patient preferred methods of learning fall prevention strategies.

The effect of methodology in determining disparities in in-hospital mortality of trauma patients based on payer source.

A retrospective registry review of adult patients admitted to a Level I trauma center sought to determine whether results regarding in-hospital mortality associated with payer source vary on the basis of methodology. Patients were categorized into 4 literature-derived definitions (Definition 1: insured and uninsured; Definition 2: commercially insured, publicly insured, and uninsured; Definition 3: commercially insured, Medicaid, Medicare, and uninsured; and Definition 4: commercially insured, Medicaid, and uninsured). In-hospital mortality differences were found in Definitions 2 and 3, and when reclassifying dual-eligible Medicare/Medicaid into socioeconomic and age indicators. Variations in methodology culminated in results that could be interpreted with differing conclusions.

The Impact of Payer Source on Trauma Outcomes in a Pediatric Population

OBJECTIVES Determine if there were differences in conclusions drawn regarding disparities in trauma outcomes based on literature-derived payer source definitions in a pediatric population. PATIENTS AND METHODS Retrospective registry review of admitted pediatric trauma patients (≤17 years of age) at a level II pediatric trauma facility. Eligible patients were categorized into 3 payer source definitions: definition 1: commercially insured, Medicaid, uninsured; definition 2: insured, uninsured; definition 3: commercially insured, underinsured. Logistic regression was used to determine the influence of payer source on outcomes. RESULTS Payer source was not significant in definition 1, 2, or 3 for intensive care unit length of stay (LOS), hospital LOS, medical consults, or mortality. For hospital disposition, payer source was significant in definition 1, the uninsured were 90% less likely than commercially insured to be discharged to continued care. In definition 2, the uninsured were 88% less likely than insured to be discharged to continued care. In definition 3, the underinsured were 57% less likely than commercially insured to be discharged to continued care. CONCLUSIONS Differences between the literature-derived definitions were not observed and therefore conclusions drawn did not differ across definitions. The investigation demonstrated payer source was not associated with in-hospital outcomes (intensive care unit LOS, hospital LOS, medical consults, and mortality), but was with posthospital outcomes. Findings warrant future examinations on the categorization of payer source in pediatric patients and hospital disposition to gain a greater understanding of disparities related to payer source in pediatric trauma, specifically in terms of posthospital care.

Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

BACKGROUND Allocating resources appropriately requires knowing whether obese patients use more resources during a hospital stay than nonobese patients. OBJECTIVES To determine if trauma patients with different body mass indexes differed in use of resources measured as a multifaceted outcome variable. METHODS A trauma registry was used for a retrospective study of adult patients admitted to a midwestern level I trauma center. Patients were stratified into 3 groups: nonobese (normal weight, overweight), obese, and morbidly obese. Three canonical correlation analyses were used to determine the relationship between patient/injury characteristics and hospital resource usage. RESULTS In a sample of 9771 patients, 71.2% were non-obese, 23.8% obese, and 5.0% morbidly obese. For patient/injury characteristics, Injury Severity Score and physiological complications were significant variables for all 3 groups. Scores on the Glasgow Coma Scale were significant for nonobese patients only. For resource usage, intensive care unit length of stay and procedures were significant variables for all 3 groups. CONCLUSIONS Associations between body mass index and outcomes have been noted when assessed as independent variables. However, when resource usage was assessed as a multifaceted outcome variable, injury factors (higher Injury Severity Score, lower scores on the Glasgow Coma Scale, more physiological complications) were associated with resource usage (increased length of stay in the intensive care unit and increased number of procedures). These findings provide clinicians a new perspective for evaluating the complex relationship between patient/injury characteristics and hospital resource usage.

Assessing the Relationship Between BMI and Resource Utilization in a Pediatric Trauma Population

In 2000, 15.5% of children surpassed the BMI for age at the 95th percentile; in 2010, this percentage increased to 16.9%.1,2 Children with higher BMIs are at an increased risk for developing cardiovascular, endocrine, and mental disorders3 and may suffer more from diseases such as asthma and obstructive sleep apnea.4–7 Even more concerning is that approximately one-half of obese school-aged children become obese adults who are then at risk for diseases associated with adulthood obesity.8–10 The cost of treating adult obesity and its related comorbidities is significant, with estimates approaching

Physician assistant program education on spirituality and religion in patient encounters

94 billion per year in 2002.11 Data related to health care utilization for overweight children are limited; 1 estimate suggests that obesity-associated inpatient hospitalization costs have risen threefold, from

Payer Source Associated with Disparities in Procedural, but Not Surgical, Care in a Trauma Population.

35 million in 1979–1981 to

Physician assistant student assessment of body mass index in children using visual cues

127 million in 1997–1999.12 Trauma is the leading cause of morbidity and mortality for pediatric patients,13 typically requiring extensive resources and expensive hospital-based health care.14 Multiple studies have reviewed the association between obesity and trauma outcomes (eg, ICU and hospital length of stay [LOS], mortality), with varied results.15–20 Single institutional studies have concluded that obese patients experiencing traumatic injuries have a higher incidence of complications,15 increased risk for ventilator support,20 and longer hospitalizations15,20 for comparable injury severity scores (ISS) than those with normal BMIs.15 In contrast, other studies have determined that there are no differences in total ventilation days or PICU LOS18 and found no association with mortality15,19 after adjusting for ISS17 in obese pediatric patients. Because hospital resources are finite, current health care economics demand optimal patient care at the lowest cost; appropriate utilization is therefore crucial. For the purposes of hospital planning and management, patient populations …