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.
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