Trauma Leadership Strategies to Prevent and Reduce Burnout in Urban Academic Trauma Centers.

The incidence of burnout syndrome is increasing among all health care disciplines. The core members of the trauma team in high-performing trauma centers are the greatest risk. It is the responsibility of trauma leadership to raise awareness of risk factors, implement standardized assessment tools, and develop strategies to mitigate burnout in employees. The consequences of burnout are devastating to providers' well-being as well as patient safety. Burnout can lead to increased risk of anxiety, depression, substance abuse, and suicide among team members. The development of burnout in team members can negatively impact patient safety. It can increase the risk of medical errors, health care-acquired infections, and declining patient satisfaction scores. It is essential that professional organizations raise awareness of this health care epidemic and provide resources to leaders to impact change.

Improving geriatric trauma outcomes: A small step toward a big problem.

BACKGROUND: Because of the unique physiology and comorbidities of injured geriatric patients, specific interventions are needed to improve outcomes. The purpose of this study was to assess the effect of a change in triage criteria for injured geriatric patients evaluated at an American College of Surgeons Level I trauma center. METHODS: As of October 1, 2013, all injured patients 70 years or older were mandated to have the highest-level trauma activation upon emergency department (ED) arrival regardless of physiology or mechanism of injury. Patients admitted before that date were designated as PRE; those admitted after were designated as POST. The study period was from October 1, 2011, through April 30, 2015. Data collected included demographics, mechanism of injury, hypotension on admission, comorbidities, Injury Severity Score (ISS), ED length of stay (LOS), complications, and mortality. Bivariate and multivariable analyses were used to compare outcomes between the study groups (p < 0.05 was considered significant). χ or Fisher's exact test was used as appropriate for bivariate analyses of categorical variables; patients' ages were compared using the Wilcoxon rank-sum test. RESULTS: A total of 2,269 patients (mean, 80.63 years; mean ISS, 12.2; PRE, 1,271; POST, 933) were included in the study. On multivariable analysis, increasing age, higher ISS, and hypotension were associated with higher mortality. POST patients were more likely to have an ED LOS of 2 hours or shorter (odds ratio, 1.614; 95% confidence interval, 1.088-2.394) after controlling for hypotension, ISS, and comorbidities. POST mortality significantly decreased (odds ratio, 0.689; 95% confidence interval, 0.484-0.979). CONCLUSION: Based on age alone, the focused intervention of a higher level of trauma activation decreased ED LOS and mortality in injured geriatric patients. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.