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A Multicenter Performance Improvement Program Uses Rural Trauma Filters for Benchmarking

An Evaluation of the Findings

Coniglio, Ray MSN, RN; McGraw, Constance MPH; Archuleta, Mike MSN, RN, CCRN; Bentler, Heather ADN, RN; Keiter, Leigh ADN, RN; Ramstetter, Julie BSN, TCRN, RN; Reis, Elizabeth MSN, RN, CEN; Romans, Cristi ADN, RN; Schell, Rachael BSN, RN; Ross, Kelli ADN, RN; Smith, Rachel BSN, RN; Townsend, Jodi BSN, RN; Orlando, Alessandro MPH; Mains, Charles W. MD, FACS

doi: 10.1097/JTN.0000000000000337

Colorado requires Level III and IV trauma centers to conduct a formal performance improvement program (PI), but provides limited support for program development. Trauma program managers and coordinators in rural facilities rarely have experience in the development or management of a PI program. As a result, rural trauma centers often face challenges in evaluating trauma outcomes adequately. Through a multidisciplinary outreach program, our Trauma System worked with a group of rural trauma centers to identify and define seven specific PI filters based on key program elements of rural trauma centers. This retrospective observational project sought to develop and examine these PI filters so as to enhance the review and evaluation of patient care. The project included 924 trauma patients from eight Level IV and one Level III trauma centers. Seven PI filters were retrospectively collected and analyzed by quarter in 2016: prehospital managed airway for patients with a Glasgow Coma Scale (GCS) score of less than 9; adherence to trauma team activation criteria; evidence of physician team leader presence within 20 min of activation; patient with a GCS score less than 9 in the emergency department (ED): intubated in less than 20 min; ED length of stay (LOS) less than 4 hr from patient arrival to transfer; adherence to admission criteria; documentation of GCS on arrival, discharge, or with change of status. There was a significantly increasing compliance trend toward appropriate documentation of GCS (p trend < .001) and a significantly decreasing compliance trend for ED LOS of less than 4 hr (p trend = .04). Moving forward, these data will be used to develop compliance thresholds, to identify areas for improvement, and create corrective action plans as necessary.

Trauma and Prehospital Services, Centura Health Trauma System, Centennial, Colorado (Messrs Coniglio, Archuleta, and Orlando, Mss McGraw, Bentler, Keiter, Ramstetter, Reis, Romans, Schell, Simms, Smith, and Townsend, and Dr Mains); Trauma Services Department, St Anthony Hospital, Lakewood, Colorado (Messrs Coniglio, Archuleta and Orlando, Ms McGraw, and Dr Mains); Trauma Research Department, Swedish Medical Center, Englewood, Colorado (Ms McGraw and Mr Orlando); and Trauma Services Department, Penrose St-Francis Hospital, Colorado Springs, Colorado (Ms McGraw, Mrs Coniglio, Archuleta, and Orlando, and Dr Mains).

Correspondence: Ray Coniglio, MSN, RN, St Anthony Hospital, 9100 E. Mineral Circle Centennial, Colorado 80112 (

The authors declare no conflicts of interest.

Supported by Centura Health Trauma System.

Copyright © 2018 by the Society of Trauma Nurses.