Abstract

BackgroundThe Joint Trauma System has demonstrated improved outcomes through coordinated research and process improvement programs. With fewer combat trauma patients, our military American College of Surgeons level 2 trauma center’s ability to maintain a strong trauma Process Improvement (PI) program has become difficult. As emergency general surgery (EGS) patients are similar to trauma patients, our Trauma and Acute Care Surgery (TACS) service developed an EGS PI program analogous to what is done in trauma. We describe the implementation of our novel EGS PI program and its effect on institutional PI proficiency.MethodsAn EGS registry was developed in 2013. Inclusion criteria were based on AAST published literature. In 2015, EGS registrar and PI coordinator positions were developed and filled with existing trauma staff. A formal EGS PI program began January 1, 2016. Pre- and post-program data was compared to determine the effect including EGS PI events had on increasing yield into our trauma PI program.ResultsIn 2016, TACS saw 1001 EGS consults. Four hundred forty-four met criteria for registry inclusion. Eighty-two patients had 131 PI events; re-admission within 30 days, unplanned therapeutic intervention, and unplanned ICU admission were the most common events. Capture of EGS PI events yielded a 49% increase compared with 2015.ConclusionOverall patient volume and PI events post EGS PI program initiation exceeded those prior to implementation. These data suggest that extending trauma PI principles to EGS may be beneficial in maintaining inter-war military and/or lower volume trauma center readiness.

Highlights

  • The Joint Trauma System has demonstrated improved outcomes through coordinated research and process improvement programs

  • As American College of Surgeons Committee on Trauma (ACSCOT) verified trauma centers with established Process Improvement (PI) programs have demonstrated improved outcomes [1], it was anticipated that applying these principles with emergency general surgery (EGS) patients would result in similar improved outcomes

  • It was acknowledged that expansion of trauma PI to EGS patients, could provide an opportunity to maintain our overall system proficiency at providing critical analysis of the care provided to our patients through the maintenance of its backbone- a strong process improvement (PI) program [2]

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Summary

Introduction

The Joint Trauma System has demonstrated improved outcomes through coordinated research and process improvement programs. With fewer combat trauma patients, our military American College of Surgeons level 2 trauma center’s ability to maintain a strong trauma Process Improvement (PI) program has become difficult. As American College of Surgeons Committee on Trauma (ACSCOT) verified trauma centers with established PI programs have demonstrated improved outcomes [1], it was anticipated that applying these principles with EGS patients would result in similar improved outcomes. It was acknowledged that expansion of trauma PI to EGS patients, could provide an opportunity to maintain our overall system proficiency at providing critical analysis of the care provided to our patients through the maintenance of its backbone- a strong process improvement (PI) program [2]. As pointed out in National Academies of Science Engineering Medicine report, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury, maximum benefit from PI requires its implementation at the provider

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