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Wed Apr 1 20:42:04 BST 2009

WOW
Very interesting
Thanks for the work

A) There is no Medical cases in these ? (I assume not)
B) Not all Trauma are equal, time is not always an issue
The graph would be more relevant if it was correlated to an Appache score or sentinel Vital signs or Treatments ? (More work ;-)
C) What percent of these actually were transfered by Medevac ?  Trauma center Ambulance ?  Local team & Ambulance ?
D) Does your Trauma center have a well structured ER outreach program ?
E) Are there formal follow-up and feedback mechanisms

Having worked for Medical Medevac (transfer) teams (Fixed wings) 
We normaly spend quite a bit of time at the referring hospital (++ Peds Teams)
This gives a good opportunity for effective personnal  training and feedback (expensive, improvised... but effective)

Trauma is more of a swoop and run operation with more limited interaction with local medical teams
Many tarmac pick-ups

Charles

----- Original Message ----
From: "Bjorn, Pret" <pbjorn at emh.org>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Wednesday, April 1, 2009 10:27:13 AM
Subject: Rural turn-around times

I'm trying to determine whether our regional trauma system is producing
changes in practice.  An immediately accessible process indicator would
seem to be referring hospital turn-around time (see Natasha Richardson).
So I pulled a decade's worth of records off of our registry:
in-transferred patients with ISS>15.  After no small effort I was able
to calculate each patient's time interval at the first hospital, which I
plotted and trended.  The result is appended.

I won't try to influence opinions on the result; but before anyone
scoffs at the intervals, please note: the service area comprises 21
hospitals scattered over about 26,000 square miles.  Just under half
these hospitals are within 50 ground miles, but the rest go out as far
as 200.  Licensed bed capacity runs from 0 to 175.  EM coverage may be
one or more physicians, or an extender on the night shift.  General
surgery coverage is about fifty-fifty overall during business hours, and
changes from day to day, shift to shift.  

I've got the data wonks looking at my math and compensating for the
outliers and calculating the p values and such.  But at least the trend
line slopes in the right direction.

I'd be interested in all comments, especially if anyone is aware of even
rudimentary benchmarks for this sort of analysis.  We submit to the
NTDB; but a) our experience with its like-hospital comparisons has not
inspired confidence thus far; and b) I've zero experience asking for
custom reports, and wouldn't know where to begin.

There.  Opinions?  Suggestions?  Be gentle.

Pret Bjorn, RN
Bangor, ME USA

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Rural turn-around times