1. ©2011 MFMER | slide-1 Trauma Site Visits Wayne Street RN Meeting Name Here And Date Here City – Location Identity

2. ©2011 MFMER | slide-2 Objectives Level III and Level VI trauma site visit The pre-meeting conference Facility Commitment The Tour PI and Chart review Type the footnote/source in this space

3. ©2011 MFMER | slide-3 Expectations Collaboration vs Hard Core battle Medical Director be present for introductions and PI / chart review TPM all day Registrar available / Report generation Letter of Commitment from the Board Working room for the day Evidence of loop closure projects Type the footnote/source in this space

4. ©2011 MFMER | slide-4 Typical Schedule 9-10 am - meet and greet / Opening presentation ( include VP ) 10-1130 Tour and asking questions 1130 – 1330 working lunch, chart review and PI Injury prevention activities 1330 Exit interview ( TMD, VP ) Type the footnote/source in this space

5. ©2011 MFMER | slide-5 Meet and greet / Exit interview Main players of the trauma system Difference between East III - N/S/W Level III TPM, TMD, Registrar ED MD director, ED RN director Lab, Radiology, VP, OR Director, CC Director, EMS Liaison “Who we are” presentation Type the footnote/source in this space

6. ©2011 MFMER | slide-6 The Tour Follow the Check list Follow the flow of the patient through the system Helipad and EMS bay – Safety, Communication Resuscitation room – Equipment and Team Lab – standardized protocols/blood Radiology – standardized protocols/need for CT Operating Room and Critical Care Type the footnote/source in this space

7. ©2011 MFMER | slide-7 The People “TEAM” Level III Surgeon or MD response and tracking ATLS for MDs, TNCC or RTTDC for RNs Continuing education Are they showing up to the traumas Type the footnote/source in this space

8. ©2011 MFMER | slide-8 Trauma PIPS How do you know you are doing a good job? If something happens how do YOU keep from having that occur ever again in your institution? Chart review – Deaths, ISS > 15, transfer outs Registry Data Meeting minutes; Systems – Peer review Highlight loop closure Type the footnote/source in this space

9. ©2011 MFMER | slide-9 PIPS Real time -rounding -daily log Retrospective review / Registry data (Pre-chart) -TMP or designee reviews every single chart -TPM and TMD review “fall outs” - Committee review; Systems or Peer Review Type the footnote/source in this space

10. ©2011 MFMER | slide-10 PIPS – TPM and TMD – Your Gang decides Patient with a Glasgow Coma Scale <14 who did not receive a CT of the head Absence of at least hourly determination and recording of BP, pulse, respirations, and GCS for any trauma patient beginning with arrival in ED, including time spent in radiology, up to transfer to the ward, OR, ICU, death, or transfer to another hospital Comatose trauma patient leaving ED before definitive airway (endotracheal tube or surgical airway) is established Any patient sustaining a GSW to the abdomen who is managed non-operatively Patient with abdominal injuries and hypotension (SBP 4 hours after arrival in the ED Patient with epidural or subdural brain hematoma receiving craniotomy more than 4 hours after arrival at ED, excluding those performed for ICP monitoring Patient transferred out >3 hours after ED arrival Interval of >8 hours between arrival and initiation of debridement of an open tibial fracture, excluding a low velocity gunshot wound Abdominal, thoracic, vascular, or cranial surgery performed >24 hours after arrival Trauma patient admitted to the hospital under care of admitting or attending physician who is not a surgeon and ISS >9 Non-fixation of femoral diaphyseal fracture in adult trauma patient Any patient requiring reintubation of the airway within 48 hours of extubation Transfusion of > 4units PRBCs ro activation of Massive transfusion protocol ; Patients receiving Factor VIIa All trauma deaths All pediatric patients ISS > 16, Patients with ISS > 25 Re-admission ; Return to ICU "Significant events" ie Code Blue, crushing up Vicodin and trying to inject it into their IV Type the footnote/source in this space

11. ©2011 MFMER | slide-11 PIPS Systems issue – Multi-disciplinary – Not Peer Review Sign in please Minutes complete and system orientated CXR not available in timely fashion to ED MD Standard lab draw list for every trauma Red Blood warming devise in the trauma bay Hover mats Type the footnote/source in this space

12. ©2011 MFMER | slide-12 PIPS Peer Review – MDs ( Surgeon, ED ) and TPM Peer review protected No surprises Adults only please ( Professionalism), Sign in, Minutes sparse All trauma deaths ( 3 possible judgments) Missed intubations Subcutaneous chest tubes Massive blood transfusion review Type the footnote/source in this space

13. ©2011 MFMER | slide-13 PIPS Individual Counseling Conversation or a letter ( see example ) MM presentation and Article Type the footnote/source in this space

14. ©2011 MFMER | slide-14 PIPS – Simple Documentation Loop Closure CXR not available in timely fashion to ED MD Standard lab draw list for every trauma Red Blood warming devise in the trauma bay Type the footnote/source in this space

15. ©2011 MFMER | slide-15 Exit Interview Reviewers need about 20 minutes “alone” Verbal Report Strengths Opportunities for improvement Criteria Deficiencies Attendance List Recommendations: Pass, Focus visit, Paper visit Case Reviews Type the footnote/source in this space

16. ©2011 MFMER | slide-16 Closing Site reviewers will not give designation Generate a report and submit to CRC CRC makes recommendation to DHS DHS sends out 3 yr certificate and letter to CEO Type the footnote/source in this space

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22. ©2011 MFMER | slide-22 Title Here Subtitle Here Type your first bulleted point here Type your second bulleted point here First subpoint Second subpoint Type your third bulleted point here Etc, etc, etc… Type the footnote/source in this space

23. ©2011 MFMER | slide-23 Title for Chart Subtitle for Chart % East West North Type the footnote/source in this space

24. ©2011 MFMER | slide-24 Title for Chart Subtitle for Chart Type the footnote/source in this space

25. ©2011 MFMER | slide-25 Title for Chart Subtitle for Chart % East West North Type the footnote/source in this space

26. ©2011 MFMER | slide-26 Title for Chart Subtitle for Chart % East West North Years Type the footnote/source in this space

27. ©2011 MFMER | slide-27 Title for Table Subtitle for Table Column 1Column 2Column 3Column 4Column 5 Row 1Red 12.347%P<0.001 Row 2Yellow 459.226%P=0.05 Row 3Green 56.798%NS Row 4Blue 1.0 2%P>0.01 Row 5Pink 56.914%P<0.0001 Row 6Violet 25.435%P=0.01 Row 7Orange1,256.2 5%P<0.001 Type the footnote/source in this space

28. ©2011 MFMER | slide-28 Title for Organizational Chart Subtitle for Organization Chart Box 1 Box 2 Box 6 Box 3 Box 7 Box 4 Box 8 Box 5 Box 9 Type the footnote/source in this space

29. ©2011 MFMER | slide-29 Mayo Clinic Locations

30. ©2011 MFMER | slide-30 Questions & Discussion

31. ©2011 MFMER | slide-31 Presentation Grid System (4:3 Ratio)