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01-10-2018 | 2018 SAGES Oral

Review of an emergency general surgery process improvement program at a verified military trauma center

Authors: Joseph Bozzay, Matthew Bradley, Angela Kindvall, Ashley Humphries, Elliot Jessie, Judy Logeman, Jeffrey Bailey, Eric Elster, Carlos Rodriguez

Published in: Surgical Endoscopy | Issue 10/2018

Abstract

Introduction

Decreasing combat-based admissions to our military facility have made it difficult to maintain a robust trauma process improvement (PI) program. Since emergency general surgery (EGS) and trauma patients share similarities, we merged the care of our EGS and trauma patients into one acute care surgery (ACS) team. An EGS PI program was developed based on trauma PI principles to facilitate continued identification of opportunities for improvement despite our decline in trauma admissions. Analysis of the first 18 months of combined ACS PI data is presented.

Methods

EGS registry inclusion criteria was based on published Association for the Surgery of Trauma’s recommendations. Program components and PI categories were based on our existing trauma PI program. Dedicated coordinators actively reviewed and cataloged patient care and outcomes. Deviations from standard practice patterns, unplanned interventions, and other complications were abstracted, categorized, and evaluated through levels of review similar to accepted trauma PI principles. Data for the first six quarters were collated and trends were analyzed.

Results

Over 18 months, 696 EGS patients met registry inclusion criteria, with 468 patients (67%) undergoing operative intervention. Over the same time, 353 trauma patients were admitted with 158 undergoing operative intervention (56.4%). Of the 696 EGS patients and 353 trauma patients, 226 (32%) and 243 (69%) PI events were identified, respectively. Common events included unplanned therapies, re-admissions, and unplanned ICU admissions. Based on analysis of all events, four new areas for improvement initiatives were identified. Results of these initiatives included implementation of a multi-disciplinary EGS PI committee, consensus protocols, and departmental and hospital-wide actions.

Conclusion

In an 18-month period, integration of our EGS patients into a novel, combined ACS PI program facilitated recognition of an additional 226 PI events and provided a substrate for continued improvements in patient care.

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Title: Review of an emergency general surgery process improvement program at a verified military trauma center
Authors: Joseph Bozzay
Matthew Bradley
Angela Kindvall
Ashley Humphries
Elliot Jessie
Judy Logeman
Jeffrey Bailey
Eric Elster
Carlos Rodriguez
Publication date: 01-10-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 10/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6303-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Review of an emergency general surgery process improvement program at a verified military trauma center

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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