Multiregion Trauma Center Follow-Up Protocol for Transferred Trauma Patients.

BACKGROUND: Trauma centers routinely utilize the Injury Severity Score for performance improvement. Yet, transferring facilities do not always have access to patients' final Injury Severity Score. OBJECTIVE: The purpose of this project was to develop and implement a multiregion Injury Severity Score follow-up feedback protocol for transferring facilities to receive standardized information on patient treatment and the ability to calculate an accurate follow-up Injury Severity Score of transferred patients. METHODS: This project included 25 Adult and Pediatric Level I, II, and III trauma centers within three regional trauma systems in a Midwestern state. This project included trauma centers that used one of the two different trauma registry software systems as a solution to develop and implement a protocol for follow-up feedback for transferred trauma patients. A template was created to capture data posttransfer to calculate a final Injury Severity Score. RESULTS: The feedback protocol was well received by participating regions. Implementation revealed the impact of variable trauma registry software on the ability to create multi-institution feedback programs. CONCLUSION: Trauma systems can implement similar strategies to ensure transferring trauma centers routinely receive standardized, timely patient feedback.

Community-Based Academic Level I Trauma Center Prepares for the 2016 Republican National Convention.

Disaster preparedness has come to the forefront for hospitals since the 9/11 attacks in 2001. Many improvements have been made in emergency management and planning for catastrophic events. Both urban and community hospitals have the same responsibilities and commitments to their patients and communities. When the announcement was made that the 2016 Republican National Convention was going to be held in Cleveland, OH, Cleveland Clinic Akron General (CCAG) had to be confident in its abilities to handle any situation that might arise not just as a community hospital but also as a Level I trauma center. Organizing and preparing for more than a year, CCAG developed a detailed and well-thought-out preparedness program, with senior leadership implementing a clear chain of command. Developing and maintaining a strong and steady defense through detailed preparation, communication, teamwork, and organization are the keys to success.

Urinary tract infection diagnosis and response to therapy in long-term care: A prospective observational study.

BACKGROUND: The prevalence of asymptomatic bacteriuria among residents of long-term care (LTC) facilities is high, and is a source of inappropriate antibiotic prescription. OBJECTIVE: To establish symptoms and signs associated with a positive urine culture, and to determine whether antibiotic therapy is associated with functional improvement. METHODS: A total of 101 LTC patients were prospectively observed after submission of urine for culture. RESULTS: The culture positivity rate was consistent with the expected asymptomatic bacteriuria rate. Change in mental status and male sex were associated with culture positivity. Treatment decisions were not consistent with culture results. Treatment did not lead to improvement in activities of daily living scores at two days or seven days. DISCUSSION: Significant growth cannot be well predicted based on clinical variables; thus, the decision to submit urine is somewhat arbitrary. Because urine culture testing and treatment does not lead to functional improvement, restricting access to the test may be reasonable. CONCLUSION: Urine culture testing in LTC facilities does not lead to functional improvement.

HISTORIQUE: La prévalence de bactériuries asymptomatiques est élevée chez les résidents d'établissements de soins de longue durée (SLD). Elle suscite la prescription inappropriée d'antibiotiques. OBJECTIF: Déterminer les signes et symptômes associés à une culture d'urine positive et établir si l'antibiothérapie favorise une amélioration fonctionnelle. MÉTHODOLOGIE: Au total, 101 patients en SLD ont fait l'objet d'une observation prospective après l'envoi d'un prélèvement d'urine pour culture. RÉSULTATS: Le taux de cultures positives était conforme au taux prévu de bactériuries asymptomatiques. La détérioration de l'état mental et le sexe masculin s'associaient à des cultures positives. Les décisions thérapeutiques n'étaient pas en accord avec les résultats des cultures. Le traitement ne suscitait pas d'amélioration à l'indice d'activités de la vie quotidienne au bout de deux ou sept jours. EXPOSÉ: Les variables cliniques ne permettent pas de prévoir une croissance importante. Ainsi, la décision de faire une culture d'urine est quelque peu arbitraire. Puisque les cultures d'urine et le traitement n'assurent pas d'amélioration fonctionnelle, il est peut-être raisonnable de restreindre l'accès aux analyses. CONCLUSION: Dans les établissements de SLD, les analyses d'urine ne favorisent pas d'amélioration fonctionnelle.