Rural turn-around times

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*A) There is no Medical cases in these ? (I assume not)

These are all cases from our trauma registry.  Physical injuries, 3 days or more, transferred (in or out) or died.

*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 ;-)

Yeah, that's the tough part.  All of these cases are ISS>15; but I'm gonna have to brush up on my Excel skills before I can build all the necessary pivot tables.  Still and all, I'd assert that if only from a systems perspective, the rural "Issues" are mostly expressed in terms of Airway, Breathing, and Transportation.

*C) What percent of these actually were transfered by Medevac ?  Trauma center Ambulance ?  Local team & Ambulance?

Another excellent question which will require some data reformatting.  (The file export alone is adventuresome.)  But there's little doubt on either end that LifeFlight and ground CCT has had an enormous impact.  At the more remote facilities, the helicopter has become the default vehicle for major injuries.

*D) Does your Trauma center have a well structured ER outreach program ?

We're pretty proud of it: a multidisciplinary team (trauma surgeon, nurse coordinator, CCT, EM,...) travels to each referral hospital about once a year, devoting hundreds of man-hours, thousands of ground miles.  Each visit is a 2-hour "roadside to rehab" review of select cases with participation from all levels of local providers.  CME/CEU/CEH approved.  The discussion focuses heavily on clinical PI and systematized care: parallel processing, dispensing with no-yield local diagnostics, etc.  

(Dumping spine films alone -- a remnant of our dark history demanding "spine clearance" thirty years ago -- is probably saving most of these patients an average of twenty minutes' wasted time.  Current target: community hospital pan-scans.)

*E) Are there formal follow-up and feedback mechanisms ?

Written feedback within 5 days on every transfer; phone feedback on request, or when urgent or sensitive critiques are indicated.  Most feedback is composed with time management as the underlying theme.


Thanks for your interest.  Has anyone else measured the impact of their system on first-hospital turnaround?

Pret

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