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 ARCHIVES
TRAUMA-LISTTRAUMA
NURSING |
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Trauma Nurse Co-ordinator Benchmarks
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From: Karim Brohi We currently do not have 'trauma nurse coordinators' as such in the UK, although we do have many nurses with a special interest in trauma management. While TNC's are seen as a GOOD THING generally, we have been unable to find any conclusive evidence that they would make a difference to trauma management in this country. In the near future we hope to appoint a team of TNC's and would like to evaluate their role. So... What benchmarks do other centres use to evaluate the 'worth' of a TNC? We would aim for measures of both process of care and outcome. For example, 'time to clear the spine' (process) and 'hospital stay' (outcome). Have any good studies anywhere shown a significant effect? Karim
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From: Robert F. Smith We must be using the word to mean different things. The TNC is central to the ability of the trauma service to function. The TNC is like the "plant manager" for the service with the Trauma Director the CEO. When Dr. Freeark and Baker created the first US dedicated trauma unit and service at Cook County Hospital they wrote a whole paper about creating this new position of trauma nurse coordinator and how the whole concept of organized trauma care hinged on their performance. People still around from those days agree that it was because of Ms. Shoemaker, the first CCH TNC that the Trauma Unit worked. Organized trauma care requires coordinating disparate people and things over space and time for the timely benefit of the injured patient. The TNC is the only person whose title contains the word coordinate. No coordination, then plain old fragmented (non-trauma) care is what you get. Robert F. Smith, M.D.,MPH
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From: Mary James Well stated Dr. Smith. The Trauma Nurse Coordinator position is very important to the trauma department. I know of two trauma centers in Los Angeles that have given their Trauma Nurse Coordinators the title, Trauma Program Manager. I'm sure that the TNC's would love to help with benchmarks if you need assistance. Mary James, RN, BSN
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From: Debra A. Perrin-Davis I don't know of any bench marks to evaluate the TC position however, If you ask the TC's they would be happy to help. The TC's function as a nucleus in the Trauma program. Monitoring and assuring that the facility is following state regulations, coordinating patient care, heading up the quality assurance process, educating the nursing staff-monitoring certifications. These are just a few of my reponsibilities as a TC.
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From: Karim Brohi Robert... no I think we are talking about the same thing. Let me just stress that in no way am I denigrating TNC's - we are desperately keen to have them. I understand that they are integral to your system, but at the moment at the London their role is spread between a variety of people/groups or is non-existent. As you know, our trauma systems have developed along deiffernet lines from the US, arising out of necessity rather than State/ACS mandate, and therefore the TNC role has not been defined as in the US. In order for us to have a cadre of TNCs we need to pay them, and to pay them we need to get money, and to get money we need to convince some government office that they will make a difference, either financial or to patient care (or both). To do this we need to study the impact they will have on our trauma system. We have a slew of about 18 criteria that we think they may influence, of which only 3 or 4 are easily measurable. We're interested to know what centres who have TNCs - where do you most feel their effect? (in a measureable way). We envision employing a group of TNCs to provide 24 hour cover.
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From: Hernan Crisostomo Hello Karim: I 'd like to know what is the preparation (ACLS, ATLS, PHTLS, BTLS, etc.) of nurses with a special interest in trauma management in your hospital (and your country). It's very interesting for me to know what you are doing. And to the trauma-list, I ask in those countries where the trauma nurse coordinators exist, what is their role?. Thanks and regards to all Hernán CRISOSTOMO MD,MSCCH
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From: Debra A. Perrin-Davis Hernan, I'm a TC in the state of Illinois at a level II facility.. Most of us have extensive Trauma experience bedside and education. Most of us not only have all certifications known to man but teach many of them. Nurses are allowed to audit ATLS only. Our roles include-management of Trauma Registry, Injury Prevention education, Educating house staff, Assuring facility is compliant with all Hospital, Regional, and State Regulations. Policies, Procedures and Guidelines, Quality Assurance, Disaster committee. Case management. These are just a few responsibilities. Many of us wear many different hats-ie we are also the EMS coordinator, help with staffing a few days a week, Injury Prevention Specialist, ED manager, Community Educators etc. Hope this helps, Debbie
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From: Janet Price The definition of Trauma Nurse Coordinator was developed at a conference for Trauma Coordinators sponsored by the American Trauma Society in 1986, based in part on a national survey I presented at that conference. "The Trauma Coordinator promotes optimal trauma care in the context of a regionalized trauma care system through clinical activities, professional and public education, research activities, quality assurance activities and administrative functions." Since that time the American Trauma Society has continued to support individuals in the role through the activities of the Trauma Coordinator Council. In 1988 the Journal of Trauma published a position paper describing the role (Flint, C. "The Role of the Trauma Coordinator: a position paper" 28:12, 1673, 1988) and another in 1996, an article describing the status of the position (Gantt, Price, Pollock "The status of the trauma coordinator position: a national survey" 40:5, 816, 1996). Additionally, each revision of the American College of Surgeons Resources for the Optimal Care of the Injured Patient has described in increasing detail the role of the Trauma Coordinator, as they too recognize the importance of this individual in making the trauma system work both in and out of the hospital. The American Trauma Society also sponsors two courses specifically designed for trauma coordinators. The "Trauma Coordinator Core Course" is a 2-day course designed to provide novice trauma coordinators with an understanding of the multifaceted role of coordinating activities in a trauma center. The "Trauma Coordinator Advanced Course" is a 1-day course developed for the experienced trauma coordinator which addresses issues that more typically affect mature trauma programs and systems. I am unaware of any formal published studies that have benchmarked the "effectiveness" of trauma coordinators, however practical experience in hundreds of trauma centers has demonstrated that someone does need to oversee the system and pull together all those individuals who make up the trauma team for the primary purpose of expediting optimal care for the injured person. This is what the trauma coordinator does every day. For more information, please contact the American Trauma Society (www.amtrauma.org). Jan Price, RN, MSA
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From: John Trickett I have been following this thread with interest, and agree that the literature is thin when it comes to quantifying or evaluating the role and effectiveness of the TNC. One distinction which has not yet been alluded to thus far is the difference in focus of the TNC and the "Case manager" or "patient care manager" in Trauma It seems that in some larger centers this distinction is clearer - in some places the roles of TNC ( System focussed) are shared with the Case manager (Patient focussed) . It appears this distinction seems to be somewhat volume dependent - if the volume is there to justify both roles full time, and make significant financial gains (Eg Dallas) then - one or more of each may be justifed - even if they are shared (see latest issue of JEN for article.) in smaller volume sites the TNC will often fulfill the Clinical Case Manager role as well. Outcome measurement seems to be less complex - when applied to the TCM than to the system coordinator. - Just like it is easier to measure the effecivenss of the child's teacher - by look at and measuring the learing - than the effectivensss or contribution of either parent. My final comment is - its not the title that matters when starting out - as much as defining the expectations - even though these may change - look at what really needs to be done, set priorities - and give the encumbant the authority to facilitate change. Re " What benchmarks do other centres use to evaluate the 'worth' of a TNC? We would aim for measures of both process of care and outcome. For example, 'time to clear the spine' (process) and 'hospital stay' (outcome). Have any good studies anywhere shown a significant effect?" Others may be (off the cuff) : Scene response John Trickett RN BScN
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