Conference Abstracts
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tiatives developed and the subsequent challenges of implementation. Keywords: Traumatic brain injury; Abbreviated Westmead Post-Traumatic Amnesia Scale; Westmead Post-Traumatic Amnesia Scale; Post-traumatic amnesia; Emergency doi:10.1016/j.aenj.2010.08.287 Priority Zero—–The Red Blanket Reducing the transfer delay of the trauma patient from the Emergency Department to the Operating Room
Trauma Redesign Process Margaret Murphy, Carla Edwards b , Julie Seggie c a
Emergency Department, Emergency Services, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145, Australia b The Centre for Health Innovation & Partnership, Westmead Hospital, Australia c Trauma Services, Westmead Hospital, Australia E-mail addresses: Margaret
[email protected] (M. Murphy), carla
[email protected] (C. Edwards), Julie
[email protected] (J. Seggie).
Royal Brisbane & Women’s Hospital, Level 2 James Mayne Building, Herston Rd., Herston, Brisbane, QLD 4029, Australia
Keywords: Trauma team training using simulation; Trauma team redesign; Contextualising trauma team training to one’s own local environment; Organisational change using redesign methodology; Training the entire trauma team; Simulation; Education
E-mail addresses: Kerena
[email protected] Grant), William
[email protected] (M. Handy).
doi:10.1016/j.aenj.2010.08.289
Kerena Grant, Michael Handy
(K.
Introduction: Severely injured trauma patients frequently require operative management to stem exsanguination. An internal audit conducted within the Royal Brisbane and Women’s Hospital identified delays in the transfer of non-responding hypotensive trauma patients from the Emergency Room (ER) to the Operating Room (OR). As a result the Red Blanket process was adapted from Los Angeles County Trauma Centre and implemented. The Red Blanket is a process of rapid transfer to the OR that bypasses a number of the normal procedures such as consent, property lists, pre op check lists and anaesthetic availability. Data methods: Data were retrospectively collected from the Queensland Trauma Registry (January 2006 to October 2007) and prospectively by the Trauma Service based on documented activation of the Red Blanket Protocol (November 2007 to February 2010). Inclusion criteria included trauma patients with a systolic blood pressure of ≤90 who failed to respond to initial fluid resuscitation or required damage control surgery with an ISS >16. ED to OR transfer time was calculated from time of ED arrival until time of OR arrival and process times were compared. Results: Pre-implementation identified 12 cases (8 male) with a mean age of 49 yrs (range, 30—84 yrs) and a mean transfer time of 206 ±SD 140 min (median189). Postimplementation identified 20 cases (11 male) with a mean age of 35 yrs (range, 18—77 yrs) and a mean transfer time of 19 ±SD 11 min (median17) from ED to OR. This difference is statistically significant (p < 0.005). Conclusion: Results suggest that implementation of the Red Blanket protocol contributed to a reduction in mean transfer time from ED to OR by 187 min. Further decrease in transfer time may be achieved with additional research and education. Keywords: Trauma; Damage control surgery; Emergency Department; Operating theatre; Protocol doi:10.1016/j.aenj.2010.08.288
Clinical 3C Emergency to Rapid Access for TIA: Optimising diagnostics and secondary prevention in a regional setting Sharan Ermel, Lily Samson, Penni Edwards Bendigo Health, PO Box 126, Bendigo, Victoria 3552, Australia E-mail address:
[email protected] (S. Ermel). Transient Ischaemic Attack (TIA) presentations to emergency departments pose a clinical dilemma for clinicians. Access to inpatient beds and neurology expertise is restricted, especially in rural and regional areas. Evidence indicates that acute TIA presentations warrant a full assessment and diagnostic evaluation within 24 h of onset for high risk presentations, and within a maximum of 72 h for low risk presentations.1 In an audit undertaken at a Victorian regional health service emergency department (ED), it was found that these recommendations were not being realised. Of the cohort discharged directly from ED (n = 20), representing 29% of ED TIA discharges, 85% underwent a computed tomography of the brain (CTB) while in ED, and 65% had pathology drawn. Only 35% of TIA discharges underwent carotid doppler studies, with the mean delay of 8.9 days. Only 35% of the cohort were discharged on anti-platelet agents, and 15% on lipid-lowering medication. Lifestyle behaviour modification advice was provided to only 30% of the discharged cohort. Ten percent of TIA patients discharged from ED, re-presented within 28 days with either TIA or stroke. In the absence of a dedicated TIA clinic, the ED collaboratively developed a pathway to the Rapid Access Clinic (RAC). The pathway includes risk stratification and admission criteria, evidence-based assessment requirements and secondary prevention recommendations. All TIA patients being discharged to the RAC receive request slips for outpatient carotid dopplers, fasting pathology and cardiac echo, as well as TIA patient education, and RAC information. In addition, patients are being referred to the ED Hospital Admission Risk Program (ED-HARP) for co-ordination of appoint-
