Cindy Austin, Katherine Kelley, Oluwafolaranmi Sodade, Brian Draper
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引用次数: 0
Abstract
Background: Tiered trauma activation protocols help physicians prioritize the severely injured but may delay care for those with less severe injuries. While trauma nurse clinicians (TNCs) have been shown to provide efficient trauma care, their impact as primary responders for Level III trauma activations has not been studied.
Objective: This study aims to evaluate the impact of TNC response to Level III trauma activations on patient outcomes.
Methods: This pre- and postintervention study was conducted at a Midwestern United States Level I trauma center from July 1, 2023, to October 10, 2023, and included adult and pediatric trauma patients. In July 2022, we implemented a protocol where TNCs replaced physicians responding to Level III trauma activations. Data from the trauma registry and electronic medical records were analyzed before and after implementation. The primary outcome was time to computed tomography within 30 minutes. Secondary outcomes were emergency department (ED) time, hospital length of stay (LOS), and 30-day readmissions.
Results: The final analysis included 812 post-intervention patients (562 with TNCs, 250 without TNCs), of which 53% were male. Groups were comparable in age and Injury Severity Score at baseline. Patients seen by TNCs were more likely to receive computed tomography (CT) within 30 minutes (56% vs 35%, p < .0001), while ED and hospital LOS and readmission rates showed no significant difference between groups.
Conclusions: This study showed that trauma nurse clinicians' response to third-tiered activations is feasible and improves timely access to CT within 30 minutes, but it showed no effect on ED time, hospital LOS, or hospital readmissions.
背景：分层创伤激活方案帮助医生优先处理严重损伤，但可能会延误对那些较轻损伤的护理。虽然创伤护理临床医生（TNCs）已被证明可以提供有效的创伤护理，但他们作为III级创伤激活的主要响应者的影响尚未得到研究。目的：本研究旨在评估TNC对III级创伤激活的反应对患者预后的影响。方法：这项干预前和干预后研究于2023年7月1日至2023年10月10日在美国中西部一级创伤中心进行，包括成人和儿童创伤患者。2022年7月，我们实施了一项协议，跨国公司取代医生应对III级创伤激活。在实施前后分析创伤登记和电子医疗记录的数据。主要结果为30分钟内进行计算机断层扫描的时间。次要结局是急诊科（ED）时间、住院时间（LOS）和30天再入院。结果：最终纳入812例干预后患者（562例合并跨国公司，250例未合并跨国公司），其中53%为男性。各组在基线时年龄和损伤严重程度评分具有可比性。在跨国公司就诊的患者更有可能在30分钟内接受计算机断层扫描（CT） （56% vs 35%, p < 0.0001），而ED和医院LOS和再入院率在两组之间没有显着差异。结论：本研究表明，创伤护理临床医生对三级激活的反应是可行的，可以在30分钟内及时获得CT，但对急诊科时间、医院LOS或医院再入院没有影响。
期刊介绍：
Journal of Trauma Nursing (JTN) is the official journal of the Society of Trauma Nurses.
The Society of Trauma Nurses believes that trauma is a disease impacting patients through the continuum of care. The mission of STN is to ensure optimal trauma care through education, collaboration, leadership and membership engagement. As the official publication of the Society of Trauma Nurses, the Journal of Trauma Nursing supports the STN’s strategic goals of effective communication, education and patient advocacy with original, peer-reviewed, research and evidence-based articles and information that reflect the highest standard of collaborative care for trauma patients.
The Journal of Trauma Nursing, through a commitment to editorial excellence, implements STN’s vision to improve practice and patient outcomes and to become the premiere global nursing organization across the trauma continuum.
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