Occurrence screens and performance measures for trauma services

— Trauma patient transferred to another hospital > 6 hours after emergency department arrival

— Emergency department time > 2 hours (admission to disposition, including radiology) with admission supine blood pressure < 90 mm Hg

— Trauma surgeon not present in emergency department upon patient arrival when patient meets trauma service criteria

— Neurosurgeon not present in emergency department within 30 minutes from time called, when Glascow Coma Scale is < 14

— Lack of hourly emergency department nursing documentation from patient arrival to transfer or death that records physiologic parameters for trauma patients with revised trauma score (RTS) of 10 or less

— Lack of hourly emergency department nursing documentation in record of neurological status evaluations for trauma patients with diagnoses of skull fracture, intracranial injury and/or spinal cord injury

— Trauma patient admitted to nonsurgical service

— Abdominal, thoracic, vascular, cranial procedure performed greater than 24 hours after admission

— Epidural/subdural hematoma not operated on

— Epidural/subdural hematoma receiving craniotomy > 2 hours after completion of CT scan

— Unscheduled return to surgery within 48 hours

— Interval of > 6 hours between emergency department arrival and initial surgery for open join injuries or blunt compound tibial fracture

— Trauma patient not receiving laparotomy for hemoperitoneum within 1 hour of emergency department arrival

— Trauma patient with low Glascow Coma Score or stab wound to the abdomen that did not receive laparotomy

— Blood transfusions > 2 units without surgery

— Blood transfusions in emergency department or operating room of > 4 units

— Emergency department time > 8 hours

— Discharge diagnosis of cervical spine injury not indicated in admission notes

— Patients with Glascow Coma Score of < 9 who do not have a mechanical airway placed prior to disposition from the emergency department

— Patient develops complication following treatment in the emergency department, i.e.:

• deep-vein thrombosis
• pulmonary embolus
• iatrogenic pneumothorax
• reintubation within 48 hours of extubation
• tension pneumothorax discovered by X-ray
• recurrent pneumothorax requiring chest tube after chest tube removal
• wound dehiscence

— Failed intubation

— Nasotracheal tube in > 7 days

— Patient not intubated who is unable to follow commands

— Intubated patient transported without oximetry

— CT scan of head > 2 hours after admission in patient unable to follow commands and not operated on

— Intracranial pressure > 20 mm Hg sustained for > 20 minutes without therapeutic intervention or physician notification

— Chemical paralysis without kinetic bed therapy in intensive care unit

— Misplaced thoracic catheters or tubes (chest tube, venous catheters, nasogastric tubes, feeding tubes, etc.)

— PaO₂ < 60 torr or arterial O₂ SAT less than 90% for greater than 10 minutes without attempted therapy

— Patient returned from operating room with PaO₂ > 50 torr

— Patient returned from operating room with hemoglobin < 8 g %

— Cardiopulmonary arrest in intensive care unit or ward

— Immobilized patient without compression boots within first 3 weeks of case

— Inappropriate antibiotic given > 12 hours after organism susceptibility available

— Aminoglycoside serum level 3 units > accepted peak, and 1 unit > accepted trough on more than one occasion during a treatment course

— Albumin level l < 2 g %

— Diarrhea (> 4 loose stools) > 24 hours

— Patient nutrition < 15 cal/kg or > 40 cal/kg for > 24 hours

— Missed fractures (diagnosed > 24 hours after admission)

— Inadvertent drain removal

— Unplanned hospital readmission within 2 months of discharge

— Ambulance scene time > 20 minutes excluding entrapped patients and multiple victim rescue

— Emergency department time > 2 hours from admission to disposition (including radiology time) with an emergency department admission systolic blood pressure less than 90 mm Hg if age > 8 years and patient subsequently required major surgery or died

— Patient admitted under care of attending physician who is not a surgeon and injury severity score (ISS) > 10

— Unplanned return to operating room within 48 hours of initial procedure

— ISS missing unless patient DOA without autopsy report

— RTS missing unless patient intubated

— Epidural hematoma or subdural hematoma, which is not operated on with midline shift of > 2 mm on CT scan or identified on autopsy

— Patient transferred to another facility without written consent of patient or family

— Patient transferred to another facility prior to being stabilized in the emergency department

Source: Patrice Spath, RHIT, Brown-Spath Associates, Forest Grove, OR.