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Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events. Intentional steps to codify and harvest the lessons learned within the military's trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost. A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military's experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system.
Managing a trauma center involves complex clinical care, long nights and days, administrative work, self-examination, critical review of patient care and significant regulatory requirements. Performance improvement is the key element of trauma center effectiveness. No trauma center provides flawless care, thus all centers have opportunities to improve. A competent performance improvement program is critical to trauma center outcomes. This book provides key information on all aspects of trauma PI and program management. In some ways, PI is an art more than a science, so the more interaction program leaders have with strong PI programs, the more they can learn about how to improve their processes. The book outlines the generally accepted processes for identification of opportunities for improvement, which are the key component of performance improvement. This includes: rounding with care teams, contemporaneous chart review, audit filters, and voluntary submissions to the trauma program for review. This book explains how to triage opportunities for improvement, analyze them, form corrective actions, and finally achieve loop closure. The book covers the roles of the personnel in the PI program, what is required to dissect the opportunity to determine action plans, how to document the entire process, and how to keep track of opportunities for improvement to ensure that your program is progressively improving care. The final sections of the book deal with specific opportunities for improvement, action plans, and loop closure through the use of case studies. The book serves as a follow-up to Dr. Jeffrey Young’s recently published book Trauma Centers, which serves as a quick guide to the key components of trauma center administration, management, and patient care.
In order to promote greater implementation of effective, affordable and sustainable trauma systems globally, the World Health Organization and the International Association for Trauma Surgery and Intensive Care have worked collaboratively to produce these guidelines on trauma quality improvement. The response to the growing problem of injury needs to include the improvement of care of the injured. Quality improvement (QI) programs offer an affordable and sustainable means to implement such improvements. These programs enable health care institutions to better monitor trauma care services, better detect problems in care, and more effectively enact and evaluate corrective measures targeted at these problems. The goal of this publication is to give guidance on ways in which health care institutions globally can implement QI programs oriented to strengthening care of the injured. This guidance is intended to be universally applicable to all countries, no matter what their economic level. These guidelines provide basic definitions and an overview of the field of QI, so that those not familiar with this field will have a working knowledge of it. Evidence of the benefit of QI in general and trauma QI in particular is then laid out. The main part of the publication reviews the most common methods of trauma QI, written in a how-do-to fashion. This covers a wide range of techniques. The first two of these are especially emphasized as ways in which to strengthen trauma QI in the setting of low-income and middle-income countries.
Now thoroughly up to date with new chapters, Smith’s Anesthesia for Infants and Children, 9th Edition, by Drs. Peter Davis and Franklyn Cladis, covers the information you need to provide effective perioperative care for any type of pediatric surgery. Leading experts in pediatric anesthesia bring you up to date with every aspect of both basic science and clinical practice, helping you incorporate the latest clinical guidelines and innovations in your practice. Quick-reference appendices: drug dosages, growth curves, normal values for pulmonary function tests, and a listing of common and uncommon syndromes. Outstanding visual guidance in full color throughout the book. Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. More than 100 video demonstrations, including new regional anesthesia videos, echocardiograms of congenital heart lesions, anatomic dissections of various congenital heart specimens with audio explanations, various pediatric surgical operative procedures, airway management, and much more. Table of Contents has been reorganized and new chapters added on statistics, sedation, pediatric obesity, and cardiac critical care pediatrics. A new chapter on regional anesthesia for pediatrics, including video and ultrasound demonstrations online. A new chapter on dermatology, specifically for the anesthesiologist, with more than 100 photos. A new chapter on medical missions to third-world countries, including what you should know before you go. A new Questions chapter provides opportunities for self-assessment. New coverage includes cardiac anesthesia for congenital heart disease, anesthesia outside the operating room, and a new neonatology primer for the pediatric anesthesiologist.
Injuries are the leading cause of death and disability among people under age 35 in the United States. Despite great strides in injury prevention over the decades, injuries result in 150,000 deaths, 2.6 million hospitalizations, and 36 million visits to the emergency room each year. Reducing the Burden of Injury describes the cost and magnitude of the injury problem in America and looks critically at the current response by the public and private sectors, including: Data and surveillance needs. Research priorities. Trauma care systems development. Infrastructure support, including training for injury professionals. Firearm safety. Coordination among federal agencies. The authors define the field of injury and establish boundaries for the field regarding intentional injuries. This book highlights the crosscutting nature of the injury field, identifies opportunities to leverage resources and expertise of the numerous parties involved, and discusses issues regarding leadership at the federal level.
Injuries are one of the most serious public health problems facing the United States today. Through premature death, disability, medical cost and lost productivity, injuries impact the health and welfare of all Americans. Deaths only begin to tell the story. Although many injuries are minor, a large proportion result in fractures, amputations, burns, or other significant injuries that have far-reaching consequences. Now, for the first time in over 15 years, we have comprehensive estimates of the impact of these injuries in economic terms. This book updates a landmark Report to Congress from 1989. Since the report, no undertaking has addressed the incidence and economic burden of injuries with more timely data, despite major changes in the fields of prevention, reporting, and surveillance. Since the mid-eighties, new safety technologies have been developed to prevent injuries or to decrease the severity of injuries, and new policies and laws have been enacted to promote injury prevention. Chapter topics include incidence by detailed categorizations, lifetime medical costs and productivity losses as a result of injuries, and a discussion of recent trends. Lavishly illustrated with tables and graphs, this volume is a valuable reference for public health practitioners, researchers, and students alike.
Trauma surgery has increasingly become a specialized field inspired by different principles and philosophy. A good trauma surgeon is a surgeon who knows how to perform abdominal vascular, thoracic, urologic, gynecologic, and orthopaedic procedures and is able to repair multiple traumatic injuries in the best sequence possible. In this first volume, practical, up-to-date guidance is provided on the optimal critical care and ICU management of trauma patients. In addition, individual chapters focus on specific injuries in orthopaedic trauma (and especially spinal trauma) and neurotrauma, with the aim of providing a fresh view of the surgical approach and practical suggestions for improving the skills of treating surgeons. Educational issues and the organization of a trauma center are also covered. The volume will be a handy pocket guide for trainee surgeons and any surgeon, physician, or nurse who treats trauma patients. It will be particularly relevant for emergency department physicians, critical care and ICU doctors, orthopaedic surgeons, neurosurgeons, and professionals responsible for trauma care and decision making, programs of trauma education, or organization of a trauma center. Also available: Trauma Surgery Vol. 2: Thoracic and Abdominal Trauma
Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.