Hospital-based trauma quality improvement initiatives

Hashmi, Zain G.; Haider, Adil H.; Zafar, Syed Nabeel; Kisat, Mehreen; Moosa, Asad; Siddiqui, Farjad; Pardhan, Amyn; Latif, Asad; Zafar, Hasnain

doi:10.1097/ta.0b013e31829880a0

Cited by 59 publications

(40 citation statements)

References 16 publications

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“…In 2002, trauma quality improvement (TQI) initiatives were implemented at AKUH. The objective of this program was to reduce in-hospital morbidity and mortality in trauma patients [13, 14]. Despite a comparatively high mortality rate in this study, damage control surgery is an acceptable technique in a subset of severely injured trauma patients in developing countries who may not survive otherwise.…”

Section: Discussionmentioning

confidence: 99%

“…In 2002, trauma quality improvement (TQI) initiatives were implemented. Important TQI initiatives in this context included: 1) Establishing a multidisciplinary trauma team, 2) Training of faculty and residents using adapted American College of Surgeons (ACS) Advanced Trauma Life Support protocols, 3) Establishing an Emergency Room trauma rush call generation protocol, 24-hour availability of dedicated trauma resuscitation, operating rooms and computed tomography scanning, 4) Collaborating with Interventional Radiology to perform angioembolization, 5) Availability of modern intraoperative surgical devices, 6) Collaborating with Hematology to setup a massive transfusion protocol, 7) Improving post-operative care with dedicated trauma care nurses [13, 14]. …”

Section: Methodsmentioning

confidence: 99%

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Experience of damage control trauma laparotomy in a limited resource healthcare setting: A retrospective Cohort Study

Kisat

Zafar

Hashmi

et al. 2016

International Journal of Surgery

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Introduction Damage control surgery (DCS) is an established option for managing severely injured trauma patients. However, its role in the management of similar patients in the developing world is debatable. The purpose of this study is to describe characteristics and outcomes of patients undergoing DCS. Methods All trauma patients requiring laparotomies from 1996–2011 at a tertiary care hospital in South Asia were reviewed. DCS was defined in a patient who underwent a truncated laparotomy where the fascia was primarily left open, with the intention of physiological optimization in the Intensive Care Unit, followed by definitive surgery. The primary outcome was in-hospital mortality. Multivariate logistic regression was used to determine the independent predictors of mortality after adjustment for potential confounders. Results Of 258 patients, 47 underwent DCS. 40% patients were transferred from other hospitals. The time between injury and operation was 152 minutes (IQR: 90–330). Intra-operative laboratory parameters revealed a median pH of 7.16 (IQR: 7.10–7.27), median temperature of 34.7 (IQR: 34.0–35.4) and median PT of 15.9 (IQR: 12.4–21.2). 55% of the patients survived to discharge from hospital. Of those who died, 86% died before the first take back operation. Packed red blood cell transfusion and vascular injury were independently associated with mortality. Discussion Damage control surgery is feasible in developing countries, with more than 50% survival reported at one hospital. Future research should focus on critical care management. Conclusion Damage Control trauma laparotomy is feasible in tertiary care hospitals with multidisciplinary trauma teams in lesser-developed countries.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Experience of damage control trauma laparotomy in a limited resource healthcare setting: A retrospective Cohort Study

Kisat

Zafar

Hashmi

et al. 2016

International Journal of Surgery

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“…1,2 Building and strengthening these 3 components in low-and middle-income countries (LMICs) creates the capacity necessary to avert millions of deaths and much disability. [1][2][3][4][5][6] Without proper assessment of the unmet surgical need or documentation of trauma management in remote LMICs, such as the islands of the South Pacific, moving toward a standardized approach to care is difficult. [7][8][9] Surgical care disparities must be framed in a way that emphasizes the magnitude of the problem and why building surgical capacity should be at the forefront of health system strengthening.…”

Section: Discussionmentioning

confidence: 99%

Where There Is No Trauma System: A Successful Patient Evacuation in the Republic of Kiribati

Cueto

Tekanene²,

Bangao³

et al. 2019

Disaster med. public health prep.

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Research is lacking around how best to approach trauma care in resource poor settings, particularly in remote areas such as the islands of the South Pacific. Without examples of successful treatment of high-risk cases in these settings, countries are unable to move forward with developing policies and standardized procedures for emergency care.The Republic of Kiribati is a Pacific Island nation composed of 33 islands spanning over 2,000 miles in the central Pacific Ocean. With the only hospital located on Kiritimati Island and inadequate boat transportation, the government recently committed to providing an aircraft for patients to receive appropriate medical care. In 2016, a 20-year-old female, primigravida, on a neighboring island, failed to progress in labor for 24 hours and needed an emergency cesarean section. A radio call was made to Kiritimati, and a team consisting of a general surgeon, nurse, and a laboratory technician was dispatched. The patient was brought to the local clinic and flown to Kiritimati where a team was prepared to perform the cesarean section.The successful patient evacuation emphasizes the importance of a dedicated health care team, government commitment, and the constant quality communication when approaching feasibility of trauma and emergency care. (Disaster Med Public Health Preparedness. 2019;13:774–776).

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“…Education, reconfiguration of trauma services, and better provision of neurocritical care facilities do improve the quality of care to trauma-related patients. 13 14 Although the initial CT scan was difficult to interpret, the high-density spots within the vestibule should have drawn attention to a possible severe inner ear trauma ( Fig. 1A ).…”

Section: Discussionmentioning

confidence: 99%

Intralabyrinthine Penetrating Ventilation Tube with Preservation of Hearing: An Unusual Clinical Situation

Raoelina

Elzière

Michel

et al. 2014

Int. Arch. Otorhinolaryngol.

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Introduction Traumatic perilymphatic fistula is not a rare event with regards to sport activities or traffic accident. However, iatrogenic damage to the inner ear can occur following the common use of grommets and ventilation tube insertion. Objectives To report an unusual case of insertion of aeration tube into the vestibule trough the stapes footplate. Resumed Report A 62-year-old woman experienced iatrogenic penetration into the vestibule from a ventilation tube inserted for retraction pocket management. The event was misdiagnosed both by the surgeon and by the emergency room physicians, leading to delay in the management. However, preservation of the hearing function lasted for 2 weeks prior to deafness, thanks to the valve of Bast, which preserved the cochlear fluid. Conclusion This case gives us the opportunity to stress the need for systematic clinical examination of traumatic injury to the ear and to recommend performing multiplanar millimetric computed tomography scan with accurate interpretation. Traumatic injuries should be referred to a dedicated traumatic emergency referral center.

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Hospital-based trauma quality improvement initiatives

Abstract: Care management study, level IV.

Cited by 59 publications

References 16 publications

Experience of damage control trauma laparotomy in a limited resource healthcare setting: A retrospective Cohort Study

Experience of damage control trauma laparotomy in a limited resource healthcare setting: A retrospective Cohort Study

Where There Is No Trauma System: A Successful Patient Evacuation in the Republic of Kiribati

Intralabyrinthine Penetrating Ventilation Tube with Preservation of Hearing: An Unusual Clinical Situation

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