Stacy A. Drake

Suicide within 72 hours after discharge from health care settings: decedent characteristics

AbstractHealth care providers have the challenge of identifying patients at risk of committing suicide after discharge from their care. The aim of this study was to identify and describe the population committing suicide less than 72 hours after discharge from medical care. Between 2006 and 2014 in Harris County, Texas, 30 individuals were identified who met these criteria. The decedents included 27 men and 3 women with a mean age of 43.5 years. The cause of death in most cases was gunshot wound of the head. Five of the decedents had requested discharge or left against medical advice and 24 committed suicide within 24 hours. Although the sample size is small, it is one of the largest cohorts of its type.

Effects of a Systematic Quality Improvement Process to Decrease Complications in Trauma Patients with Prehospital Peripheral Intravenous Access

Peripheral intravenous (PIV) catheterization is commonly performed, and its complications are costly, may result in serious health issues, and may adversely affect patient satisfaction. At our large urban Level I trauma center, we identified a cluster of 7 PIV complications from prehospital insertions in a 5-month period. Several of the patients developed noninfectious as well as infectious, limb-threatening complications requiring aggressive operative intervention. A performance improvement project was chartered to identify the cause of PIV complications and review current nursing practice. The FOCUS-Plan Do Check Act methodology was used to measure and improve practice. With implementation of interventions and outcomes monitoring, no PIV complications were reported for the subsequent 39 consecutive months. Our findings have implications for more controlled studies to establish best practice at other Level I trauma centers across the country.

Essential Medicolegal Death Investigation Services: Standardization of a Survey Instrument Based on the Essential Public Health Services

Abstract:  The National Academy of Sciences recommends that states assess the performance of medicolegal death investigation agencies. To aid in performance assessment, we adapted an instrument based on the CDC’s 10 Essential Public Health Services by translating the terminology to that of essential medicolegal death investigation services. This produced a survey that could be used to standardize reporting practices and services of agencies. To validate the instrument, a stratified random sample of 12 death investigation chiefs in 12 states was interviewed. This sample represented both medical examiner and coroner jurisdictions within the varying medicolegal structures. A cognitive testing process elicited how well participants could respond to and interpret the survey questions. The response was favorable in that the respondents agreed that given specific revisions toward question clarification, the instrument would be a useful and relevant tool for assessing system performance.

Forensic Nursing State of the Science: Research and Practice Opportunities

Introduction: The International Association of Forensic Nurses (IAFN) is the only nursing organization advancing the forensic nursing specialty. The organization seeks to advance the profession, and one mechanism for doing so is development of a research agenda. Methods: The purpose of this action-based research study was to aid in the development of a forensic nursing research agenda. The study was carried out in two integral stages: (a) focus groups with IAFN members attending the annual conference and (b) reviewing posted IAFN member listserv material. Results: The findings of this study identified similar gaps of other nursing specialties experiencing “growing pains,” including role confusion and variation in educational preparation. Conclusion: Findings from this study will inform development of the IAFN 5-year research agenda to advance forensic nursing science and evidence-based practice.

Implementing Case Management within a Large Medicolegal Death Investigation Agency

Medicolegal death investigation agencies must provide timely final autopsy reports in order to meet minimum accreditation standards. To ensure a timely turn around, the principles of case management were introduced into an agency with a large metropolitan jurisdiction. Forensic autopsies are typically complex and the associated ancillary studies often include forensic toxicology along with various specialty consults. Beginning in 2013, a forensic case management service was initiated to aid forensic pathologists in reducing report turnaround time. Despite increasing number of cases in 2014, the agency was able to maintain the accreditation standard of 90% turn around within 90 days. The case management service required process improvement, technology to track and trend, and increased interdisciplinary collaboration. The implementation of a case management system within the forensic autopsy service can improve processes to reduce report turnaround times.

Medicolegal Death Investigation and Hospital Patient Safety and Quality Outcomes: A Naturally Synergistic Collaboration

ABSTRACT The role of medicolegal death investigation (MLDI) systems in the assessment of violent deaths (e.g., gunshots, stab wounds, car crashes) is well known. However, the role of MLDI systems in informing healthcare agencies about potential patient safety and quality improvement activities is less understood and thus the main focus of this article. In this article we describes-one agencys initiatives to identify decedents whose circumstances or cause of death had potential relevance for patient safety and quality outcomes and to communicate those findings to acute care hospitals where the decedents were previously treated. We also describes the evaluation of this communication process and provide preliminary outcomes of these efforts.

Leadership Decisions Influencing Medicolegal Death Investigation: “We wear a lot of hats.”

ABSTRACT Leaders of medicolegal death investigation agencies face leadership and management challenges. To develop a deeper understanding of how they approach these challenges in the context of the community they serve we explored their lived experiences through semi structured telephone interviews about the essential services of their agency. Qualitative interviews of 12 leaders were transcribed and reviewers identified major themes through multiple readings. The themes included: Responsibilities of Agencies, Interdisciplinary Relationships, Variations in Practice, Recruitment of Agency Personnel, Leaders Qualifications and Certification of Personnel, Training of Personnel, and Quality Improvement/Quality Assurance. The factors affecting agency leaders are complex ranging from the hiring of agency personnel to running and overseeing all aspects of death investigations. There are resources such as leadership training and mentoring needed to improve the oversight and quality of death investigation agencies in the United States.

Comparative analysis of the public health role of two types of death investigation systems in Texas: application of essential services

The purpose of this research was to assess the practices of death investigation agencies in Texas and to investigate the differences between justices of the peace (JPs) and medical examiner perceptions of their role and responsibilities. A survey was conducted in which justices of the peace and medical examiners (MEs) were questioned on their agencys policies and practices in regard to essential services provided using a recently published 50‐item instrument subdivided into 10 essential services areas. The study used a quantitative descriptive cross‐sectional design in which nonparametric analysis was used to ascertain differences between groups. The sample size for analysis was composed of 10 (83%) ME offices and 112 (15.5%) JPs. This statewide study found significant differences between MEs and JPs. These differences reflect the variation in educational background, understanding and implementation of essential services, and the appreciation of the needs of a system to be both collaborative and independent.

Stranded motorist deaths in Harris County, Texas: a deadly game of highway roulette

ABSTRACT The Centers for Disease Control and Prevention recognize that nonintentional injuries are a leading cause of death and disability. Current literature identifies risk factors and prevention strategies for motor vehicle crashes and auto-pedestrian incidents. However, scant literature provides prevention strategies for the stranded motorist (SM). The SM is defined as any occupant of a vehicle that is stopped in or on the side of a road. The purpose of this case report was to identify and describe the circumstances of SM death. Death data were identified from the medicolegal death investigation agency. Between 2004 and 2014, Harris County, Texas, had 46 SM deaths, and of those deaths, 74% occurred while outside the vehicle, and most motorists become stranded because of mechanical issues (67%). An outcome of the report was a public service announcement aimed at primary injury prevention. The medicolegal death investigation agency changed how they categorize the SM.

46 Stranded motorists injury prevention: how interprofessional collaboration informs policy

Statement of the purpose Stranded motorists are injured or die every year as the result of being hit by a motor vehicle. Scant literature about this population exists. These deaths are not differentiated from auto-pedestrian fatalities in the usual vital statistics classifications (e.g. death certificates) or other public safety databases. In effort to develop effective prevention strategies differentiating the stranded motorist from the auto-pedestrian is essential. The aims of this project were twofold: 1) identify and describe the stranded motorist population during the years of 2004–2014 and 2) establish injury prevention strategies in Harris County, Texas. The purpose of this presentation is to discuss the roles and outcomes of an injury prevention interprofessional collaboration. Methods/approach The interprofessional collaboration consisted of representatives from two level one trauma centres, Houston Transtar, which is an agency comprised of four government entities focused on Transportation Management and Emergency Management, the local medicolegal death investigation agency, and a large metropolitan university. Results The collaboration resulted in agency level changes in how stranded motorists are categorised and tracked within agency databases. We have begun statewide initiatives to incorporate database changes at the state level. Additionally, we developed a public service announcement (PSA) that was distributed throughout the region via collaborative involvement at events such as car care events. The PSA was also posted in the public website of several of the agencies. We are developing initiatives to impact state legislation to include stranded motorists in the current “Move-over” laws. Conclusion By working through an interprofessional collaboration, we were able to identify and implement injury prevention strategies for persons who become stranded on the roadside and have raised awareness of the dangers of being a stranded motorist. Significance and contributions We were able to identify gaps in current systems and have bridged those gaps through interprofessional collaboration.