Lynn Eastes

Alcohol Withdrawal Syndrome in Trauma Patients: A Review

Alcohol withdrawal syndrome (AWS) is an all-toocommon problem in trauma patients, with between 30% to 50% having ingested some type of intoxicant prior to injury. The positive correlation between alcohol use and trauma is well established in the literature. The spectrum of AWS, however, is not well understood among all trauma care providers. AWS symptoms are similar in some cases to symptoms of sepsis, progression of the brain injury, and a constellation of other diagnoses causing delirium. The purpose of this article is to review the pathophysiology of AWS, identify the common symptoms of AWS that trauma providers will encounter, discuss which trauma patients are at highest risk for AWS, and examine the trauma nurses role in reducing the risk of AWS.

Use of the electronic medical record for trauma resuscitations: how does this impact documentation completeness?

Although many trauma centers across the country have implemented electronic medical records (EMRs) for inpatient documentation, they have avoided the use of EMR during the fast-paced trauma resuscitations. The objective of this study was to determine whether documenting electronically during trauma resuscitations has resulted in improvement or degradation of the completeness of data recorded. Forty critical data points were evaluated in 100 pre-EMR charts and 100 post-EMR charts. There was improvement in completeness of charting in 25% of the electronic records reviewed and degradation of completeness of charting in 18% of the records, for a net improvement in completeness of charting of 7% in the electronic records reviewed.

Performance improvement and patient safety program-guided quality improvement initiatives can significantly reduce computed tomography imaging in pediatric trauma patients.

Background Morbidity and mortality of cervical spine (C-spine) injury in pediatric trauma patients are high, necessitating quick and accurate diagnosis. Best practices emphasize minimizing radiation exposure through decreased reliance on computed tomography (CT), instead using clinical assessment, physical examination, and alternate imaging techniques. We implemented an institutional performance improvement and patient safety (PIPS) program initiative for C-spine clearance in 2010 because of high rates of CT scans among pediatric trauma patients. Methods A retrospective review of pediatric trauma patients, aged 0 years to 14 years, in the pre- and post-PIPS implementation periods was conducted. Rates of C-spine CT, overall CT, other imaging modalities, radiation exposure, patient characteristics, and injury severity were compared, and compliance with PIPS protocol was reviewed. Results Patient characteristics and injury severity were similar before and after PIPS implementation. C-spine CT rates decreased significantly between groups (30% vs. 13%, p < 0.001), whereas C-spine plain x-ray rates increased significantly (7% vs. 25%, p < 0.001). There was no difference in C-spine magnetic resonance imaging between groups (12% vs. 10%, p = 0.11). In 2007, 71% of patients received a CT scan for any reason. However, the overall CT rate decreased significantly between groups (60% vs. 45%, p < 0.001). There was an estimated 22% decrease in lifetime attributable risk (LAR) for any cancer due to ionizing imaging exposure in males and 38% decrease in females between the pre- and post-PIPS groups. There was a 54% decrease in LAR for thyroid cancer in males and females between groups; 2014 compliance with the protocol was excellent (82–90% per quarter). Conclusions Performance improvement and patient safety program–generated protocol can significantly decrease ionizing radiation exposure. We demonstrate that a simple protocol focused on C-spine imaging has high compliance, decreased C-spine CT scans, and decreased LAR for thyroid cancer. A secondary benefit is a reduction in total CT imaging, with an associated decrease in LAR for all cancers. LEVEL OF EVIDENCE Therapeutic study, level IV; diagnostic study, level III.

A statewide teleradiology system reduces radiation exposure and charges in transferred trauma patients

BACKGROUND Trauma transfer patients routinely undergo repeat imaging because of inefficiencies within the radiology system. In 2009, the virtual private network (VPN) telemedicine system was adopted throughout Oregon allowing virtual image transfer between hospitals. The startup cost was a nominal

Financial Strategies and Outcomes Management in Trauma Care: Current Status and Predictions for the Future

3,000 per hospital. METHODS A retrospective review from 2007 to 2012 included 400 randomly selected adult trauma transfer patients based on a power analysis (200 pre/200 post). The primary outcome evaluated was reduction in repeat computed tomography (CT) scans. Secondary outcomes included cost savings, emergency department (ED) length of stay (LOS), and spared radiation. All data were analyzed using Mann-Whitney U and chi-square tests. P less than .05 indicated significance. Spared radiation was calculated as a weighted average per body region, and savings was calculated using charges obtained from Oregon Health and Science University radiology current procedural terminology codes. RESULTS Four-hundred patients were included. Injury Severity Score, age, ED and overall LOS, mortality, trauma type, and gender were not statistically different between groups. The percentage of patients with repeat CT scans decreased after VPN implementation: CT abdomen (13.2% vs 2.8%, P < .01) and cervical spine (34.4% vs 18.2%, P < .01). Post-VPN, the total charges saved in 2012 for trauma transfer patients was

Use of the personal digital assistant for point-of-care trauma documentation

333,500, whereas the average radiation dose spared per person was 1.8 mSV. Length of stay in the ED for patients with Injury Severity Score less than 15 transferring to the ICU was decreased (P < .05). CONCLUSIONS Implementation of a statewide teleradiology network resulted in fewer total repeat CT scans, significant savings, decrease in radiation exposure, and decreased LOS in the ED for patients with less complex injuries. The potential for health care savings by widespread adoption of a VPN is significant.

Using the Electronic Medical Record for Trauma Resuscitations: Is it Possible?

In the competitive health care market of the 1990s, trauma centers face a multitude of fiscal challenges that threaten their survival. Trauma centers are confronted with the tremendous task of balancing the cost of caring for the patient with multiple trauma who requires resource-intensive care with the most fiscally responsible outcomes. Academic medical centers and residency training programs are faced with an even greater burden associated with controlling cost while providing learning experiences for physicians and nurses. Outcomes management represents the future strategy that trauma centers nationwide must embrace. Outcomes management gives trauma centers the opportunity to demonstrate their contribution to the community and society through improved patient and systems outcomes.