Trauma center boosts patient outcomes
Trauma center boosts patient outcomes
Good outcomes jump from 27% to 73%
Mission Hospital in Mission Viejo, CA, has improved its percentage of good patient outcomes for traumatic brain injury (TBI) patients from 27% in 1994 to 73% today. According to the Joint Commission on Accreditation of Healthcare Organizations, Mission Hospital’s trauma mortality rate is 30% less than the national average. The hospital’s trauma center attributes that success to a unique trauma nurse program that provides continuity of care during admission, diagnosis, and initial treatment.
The hospital’s clinical outcomes for patients sustaining severe TBI from January 1994 to May 1997 were marginal at best, with 43% expiring and 30% suffering severe disability. In 1995, the American Association of Neurological Surgeons (AANS) published evidence-based clinical guidelines for managing TBI based on research that examined the outcomes of various treatment modalities.
In 1997, the trauma center seized on these recommendations, and a multidisciplinary trauma team initiated a performance improvement process that examined current practice and established new hospital-based clinical guidelines. "We asked our doctors and nurses to completely change the way they manage head injuries," says Mary Kay Bader, neuroclinical nurse specialist at Mission. She says Mission made "a total commitment" to bring its practices in line with those new guidelines.
According to Bader, that required extraordinary changes in the trauma center. "It requires a lot of education, bedside support, and mentoring," she explains. That included trauma surgeons, neurosurgeons, nurses, and others. Those changes were motivated by the scientific guidelines published by the AANS, Bader says. "We took the entire booklet and implemented those scientific guidelines." Notably, the guidelines were revised in 2000, and the authors revealed survey data showing that less than 20% of the country’s trauma centers had fully adopted the guidelines, while another 40% had adopted only portions of them, she says.
Another key ingredient to success has been staffing patients according to their needs rather than just adhering to blanket policies, Bader explains. "We are blessed that we have an administration that supports meeting the needs of the patient. It does cost more money to manage these patients, but our outcomes have been enhanced," she adds. "Instead of dying or going to a nursing home, [patients] are going back to work and school."
Mission has a panel of neurologist and a neuroclinical nurse specialist who work with the emergency department team to manage stroke patients. Trauma center physicians have nearly 100 years combined experience, and each is board-certified. The trauma center is certified by the American College of Surgeons (ACS), Committee on Trauma as a Level II trauma center. Notably, only 20% of the hospitals in the country have sought verification and received the designation since the ACS began the program in 1987. The center also has been accredited by the Orange County (CA) Emergency Medical Services Agency since 1980.
Mission employs state-of-the-art technology such as the spinal CT scanner and portable ultrasound, as well as the latest procedures and technology for the repair of vascular injuries and advanced techniques in the care of severe respiratory conditions.
"I think every hospital in the country has a CT scanner," says Bader. On the other hand, there are still trauma centers that treat head injury patients without putting a pressure monitor in the patient’s brain even though that technology has been available for years. "It is a $100 piece of equipment," she says. "But some neurosurgeons and trauma centers refuse to change their practice.
According to Bader, Mission’s in-house acute rehabilitative unit ensures continuity of care. An interdisciplinary team meets weekly to discuss patient needs, including metabolic requirements, rehabilitative needs, social service, and discharge needs. "Our team incorporates not only the intensive care phase but the surgical and rehab units," she says.
Occupational and physical therapists are involved in the patient’s treatment from the outset. "They become aware of the patient’s needs early on, and that provides continuity," says Bader. Specially trained nurses who have completed the Advanced Trauma Care for Nursing program are based in Mission’s trauma/neuro intensive care unit (ICU).
When emergency surgery is required, a trauma nurse stays with the patient and monitors all physiologic needs as well as communications with family members. According to Bader, those nurses meet the patient as well as the family at the outset. She says that helps facilitate the patient’s transition from the ICU to the surgical unit and the rehab unit. "There is a very smooth transition," says Bader. "I think that makes a big difference." In addition, 24-hour pastoral care provides support for family members throughout the patient’s stay.
Mission is one of only three designated trauma centers in all of Orange County. As the largest medical center in south Orange County, the trauma center treats nearly 700 traumas each year.
Mission’s work in this area has been acknowledged by the American Association of Critical Care Nurses (AACN) in Aliso Viejo, CA, which recently awarded Mission Hospital with the prestigious AACN Mutidisciplinary Team Award. In 1994, the hospital became one of 14 Catholic, not-for-profit hospitals operated by the St. Joseph Health System and sponsored by the Sisters of St. Joseph of Orange. Last year, the Trauma Center was awarded the coveted Codman Award from the Joint Commission.
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