Devastating effects of alcohol are well established in trauma. To address this, thve American College of Surgeons Committee on Trauma (ACS-COT) requires ACS-verified Level 1 trauma centers to have an active screening, brief intervention, and referral to treatment (SBIRT) program. In 2015, NewYork-Presbyterian/Queens successfully implemented an SBIRT program. Previous studies indicate difficulty in achieving a high level of SBIRT compliance. We explored the effects of a multidisciplinary approach in implementing a standardized screening protocol for every trauma-activated patient 15 years or older. A multidisciplinary team developed a standardized approach to identifying trauma patients for our SBIRT program. Social workers were trained in performing brief interventions and referral to treatment at a New York State-level training course prior to starting our SBIRT program. Blood alcohol levels were obtained in every trauma activation. Trauma patients who had a blood alcohol level greater than 0.02% were identified and tracked by the trauma service. These patients were referred to social workers, underwent brief intervention, and evaluated for referral to treatment if determined to be a high-risk alcohol user. Over the 8-month implementation period, we evaluated 693 trauma patients. A blood alcohol level was obtained on most trauma patients (n = 601, 86.6%). Patients with a blood alcohol level greater than 0.02% were referred to a social worker (n = 157, 22.6%). Social workers performed a brief intervention and evaluation for referral/treatment services for 129 of the trauma patients with elevated blood alcohol levels. Overall, 82% of intoxicated trauma patients underwent brief intervention, which identified 22 patients who were referred for treatment programs. An inclusive multidisciplinary approach to the implementation of an SBIRT program achieves a high level of compliance.

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BackgroundThe documentation of physician arrival is an important component of trauma resuscitation. The American College of Surgeons (ACS) requires attending physicians at Level I and Level II trauma centers to arrive to the most critical traumas, full trauma team activations (full activations), within 15 minutes at 80% compliance, and to limited trauma team activations (limited activations) within a timely manner, which we designated as 60 minutes. However, our institution’s rates of documentation and compliance using a paper-based trauma flowsheet (TFS) were found to be well below the 80% compliance rate.MethodsPhysicians began using a radio-frequency identification (RFID) badge to swipe into the emergency department (ED) upon arrival to the trauma room. Arrival times were taken from the swipes data and used to supplement missing or non-compliant times on the TFS. If a TFS was missing a time, it was considered both undocumented and noncompliant. A two-proportion z-test was used to compare the rates of documentation and compliance before and after the addition of swipes data.ResultsDocumentation rates for full activations rose from 76% to 90%. Compliance rates for full activations rose from 70% (below the requirement) to 84% (compliant). Limited activation documentation and compliance rose significantly from 47.2% and 45.3% to 67.4% and 63.4%, respectively. Total documentation rose significantly from 49.9% to 69.7%. We went from below compliance to above compliance with the addition of the RFID system.ConclusionThe use of the RFID technology improved the rates of documentation and compliance of attending physician arrival to trauma activations. Rates rose between 14 and 20 percentage points in each category, significantly in total documentation and in limited activation documentation and compliance. The addition of RFID swipes data made our rates improve to become compliant.

Introduction Designated high-quality trauma services have been shown to improve outcomes of trauma patients by virtue of access to specialized personnel and resources. It remains unclear if a ‘halo effect’ extends these benefits more generally to non-trauma populations. Obstetric patients who develop severe postpartum hemorrhage often require close attention in intensive care units and utilize more resources. Given the overlapping needs between trauma and obstetric patients, we hypothesize that the ‘halo effect’ might extend to patients with severe postpartum hemorrhage. Methods The Nationwide Inpatient Sample for years 2008 to 2011 was queried. Patients with severe postpartum hemorrhage were identified as those requiring transfusion, hysterectomy, or uterine repair. After stratifying by level 1 trauma center versus non-level 1 trauma center status, unadjusted univariate comparisons were made. Adjusted odds ratio of end-organ failure and death were analyzed using multivariable logistic regression. Results A total of 11,135 patients were identified with severe postpartum hemorrhage. The majority were hospitalized at non-level 1 trauma centers rather than level 1 trauma centers (71.4% vs. 28.6%). Patients at non-level 1 trauma centers were younger, more likely to be white, admitted electively, insured, and healthier with a lower comorbidity index. There was no significant difference in rates of mortality or organ failure. However, after adjustment for differences in comorbidity index, race, and emergency admission, patients at non-level 1 trauma centers had a significantly higher risk of respiratory failure (odds ratio, 1.27; 95% confidence interval, 1.01–1.59). Conclusions These findings suggest that the outcomes of obstetric patients with severe postpartum hemorrhage admitted in level 1 trauma centers are not overall significantly different when compared to those in non-level 1 trauma centers. However, after adjusting for baseline characteristics, there was a reduced risk of respiratory failure in patients admitted to level 1 trauma centers.