Trauma Center Characteristics and Performance Improvement: A Review, Exams of Traumatology

Download Trauma Center Characteristics and Performance Improvement: A Review and more Exams Traumatology in PDF only on Docsity! TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) List the characteristics of Trauma Center Designation - correct answer Outlined and developed at the state and local level Varies from state to state Requirements outlined through legislative or regulatory authority List the characteristics of Trauma Center Verification - correct answer Overseen by the American College of Surgeons Verifies commitment, readiness, resources, policies, patient care and performance improvement are in place. What is the definition of level 5 Trauma Care? - correct answer Provides evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care. What are the level 5 Trauma Care criteria? - correct answer Basic ED facilities to implement ATLS protocols Trauma nurses and physicians available upon patient arrival After-hours activation protocols if facility not open 24-hours a day TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) May provide surgery and critical-care services if available Has developed transfer agreements for patients requiring more comprehensive care a a level 1 through 3. What is the definition of level 4 Trauma Care? - correct answer Provides evaluation, stabilization and diagnostic capabilities for injured patients before transferring to a higher level of care. What are the level 4 Trauma Criteria? - correct answer Basic ED implement ATLS protocols and 24 hour laboratory coverage. Trauma nurses and doctors available on patient arrival. May provide surgery and critical care services when available. Transfer agreements with Level 1 or II. Comprehensive quality assessment program. Involved in prevention efforts and must have an active outreach program for its referring communities. TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) Operates an organized teaching and research effort to help direct new innovations in trauma care. According to COBRA / EMTALA, what must accompany the patient upon transfer? - correct answer Signed certification of risks/benefits Appropriate medical records, reports and consultation records (or copies) According to _____, appropriate transportation with adequate life support equipment trained personnel on board (based on patient's condition) is required for transfer. - correct answer COBRA/EMTALA What is the term for a process which seeks to improve the quality of care provided? - correct answer Process improvement What are the three steps to process improvement? - correct answer 1. Identification of outcomes 2. Determining a plan to meet those outcomes TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) 3. Measuring progress toward the outcomes What is TRISS? - correct answer Trauma Injury Severity Score How are patients selected for performance improvement? - correct answer Varies from institution to institution What does the TRISS do? - correct answer Trauma injury severity score calculates the probability of survival for patients based on criteria. What criteria are used in assigning a TRISS score? - correct answer Revised Trauma Score (RTS), includes respiratory rate GCS Systolic BP Patient age Mechanism of Injury (blunt vs. penetrating) Abbreviated Injury Score (AIS) TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) Discuss the Abbreviated Injury Score (AIS) - correct answer The AIS assigns each injury a score of 1-6. Once a score is assigned, it is squared. Only the THREE most severely injured body areas are scored using the highest score in each body region. Scores vary from 0 to 75. The higher the score, the lower the likelihood for survival. What is used to collect, store and retrieve data describing the etiologic factors, demographic characteristics, diagnoses, treatments, and clinical outcomes of individuals who meet specific case criteria. - correct answer Trauma Registry What are the 3 types of performance improvement reviews? - correct answer Primary Secondary Tertiary TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) Was the system response optimal? Did the patient have pre-existing medical conditions that contributed to the occurrence? Was the occurrence evident before hospitalization? What are some system shortfalls to consider in review? - correct answer Prolonged prehosiptal time Communications problems Paging system failure Delays in internal response Blood bank delays Equipment malfunctions What 3 things will performance improvement reviews help determine? - correct answer 1. If traumatic death was preventable, potentially preventable, or non-preventable 2. What can be learned from the case to improve care in the future TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) 3. Whether there were delayed injuries (found after admission) or missed injuries (found after discharge) Based on the findings of performance improvement, what appropriate actions can be undertaken? - correct answer collection of data for a period of time to determine whether the variation represents a trend or an isolated occurrence Change in, or better enforcement of, policy or procedure Development of clinical management guidelines Presentation of the issue as a topic of education Physician/Provider counseling Mandatory continuing education Probation or suspension of staff members who have varied from the standard of care What is loop closure? - correct answer Based on actions undertaken, address issues noted in performance improvement reviews. It is TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) important to ensure those actions have had their intended effect. This is also referred to as loop closure. What is the term for the conscious, explicit and judicious use of current best evidence in making decisions about the care of individual patients? - correct answer Evidence-Based Practice What are 4 advantages to evidence-based practice? - correct answer Enhances patient outcomes Allows measurement of outcomes Reduces individual practitioner roles Increases cost effectiveness of care and resource use Define quantitative research - correct answer A deductive process that utilizes numeric findings for quantification TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) List 10 factors that should be considered when reviewing research. - correct answer 1. Is the study design appropriate to the type of research done? 2. Do the study findings address current clinical problems? 3. Is the subject population for the study appropriate? Was there an appropriate number of subjects in the study? 4. Is the study applicable to current practice and the area it is to be applied? 5. Is the study population similar to those with whom the research will be applied? 6. Is the study's setting similar to or different from the intended practice setting? 7. Is there evidence that a critical review of literature was done before the research was undertaken? 8. Are the research instruments reliable and valid? 9. Do other studies support or oppose the study findings? 10. Was the study ethical, legal, and feasible? TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) What is the goal of mitigation? - correct answer To reduce loss of life and property by limiting or avoiding potential impact and incorporating lessons learned from previous events What is the goal of disaster triage? - correct answer To do the most good for the greatest number of people What are the 4 steps to disaster management? - correct answer Mitigation Preparedness Response Recovery Shorten the meaning of mitigation - correct answer "What do we need to get ready?" TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) What are the steps of mitigation? - correct answer Hazards Vulnerability Analysis Take actions to reduce risks identified during Hazards Vulnerability Analysis What is the act of determining the hazards that a hospital is at risk for, so actions can be taken to minimize those risks? - correct answer Hazards Vulnerability Analysis Shorten the meaning of preparedness - correct answer Getting things ready What are the 4 steps to preparedness? - correct answer 1. Develop mutual aid agreements and contracts 2. Determine/stockpile resources needed for five days of autonomous functioning. 3. Develop disaster plans, educate staff on those plans, and perform disaster drills to practice the plans TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) Debriefing What is a three-step informal process that occurs right after the event (preferably before the participant sleeps) - correct answer Defusing What is an eight-step formal process that takes place 1-14 days after the event? - correct answer Debriefing Discuss the CISM - correct answer Activated for any incident which potentially creates emotional distress for those involved Is not a quality improvement activity or an event to air concerns The purpose is to mitigate the impact of traumatic events and restore adaptive functioning of care givers Led by trained counsellors Only those present during the event are invited to attend TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) What is the term for the ability of an individual to determine his or her own course of action. Included in this principle are independence, self- reliance and competency. - correct answer Autonomy What is the term for the duty of health care providers to be of a benefit to the patient, as well as to take positive steps to prevent and to remove harm from the patient? - correct answer Beneficence What term requires that we not intentionally create needless harm or injury to the patient, either through acts of commission or omission? - correct answer Non-Maleficence What is the term for providing all information needed to make an informed and balanced decision? - correct answer Honesty or Veracity What is the term for the fair distribution of goods in society? - correct answer Justice TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and Standards, Education and Outreach, Trauma Registry and Ethical Issues) (questions and answers) What is information that relates to past, present or future physical or mental health or condition of an individual; provision of health care to an individual, and past, present or future payment for the provision of health care to the individual? - correct answer Protected Health Information What ensures patients will receive information about how their health data will be used and disclosed? - correct answer Health Information Portability and Accountability Act (HIPAA) List the instances in which patient consent is not required for their information to be shared. - correct answer Information may be shared between one or more health care workers involved in the patient previously or in the future. Information may be shared if the activities involve obtaining premiums, determining or fulfilling responsibilities for coverage and provision of benefits, and furnishing or obtaining reimbursement for health care delivered to an individual. Health care operation activities