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Smartphone application alerts for early trauma team activation: Millennial technology in healthcare

Goulet, Nicole D; Liu, Helen; Petrone, Patrizio; Islam, Shahidul; Glinik, Galina; Joseph, D'Andrea K; Baltazar, Gerard A
BACKGROUND:Data access through smartphone applications (apps) has reframed procedure and policy in healthcare, but its impact in trauma remains unclear. Citizen is a free app that provides real-time alerts curated from 911 dispatch data. Our primary objective was to determine whether app alerts occurred earlier than recorded times for trauma team activation and emergency department arrival. METHODS:Trauma registry entries were extracted from a level one urban trauma center from January 1, 2018 to June 30, 2019 and compared with app metadata from the center catchment area. We matched entries to metadata according to description, date, time, and location then compared metadata timestamps to trauma team activation and emergency department arrival times. We computed percentage of time the app reported traumatic events earlier than trauma team activation or emergency department arrival along with exact binomial 95% confidence interval; median differences between times were presented along with interquartile ranges. RESULTS:Of 3,684 trauma registry entries, 209 (5.7%) matched app metadata. App alerts were earlier for 96.1% and 96.2% of trauma team activation and emergency department arrival times, respectively, with events reported median 36 (24-53, IQR) minutes earlier than trauma team activation and 32 (25-42, IQR) minutes earlier than emergency department arrival. Registry entries for younger males, motor vehicle-related injuries and penetrating traumas were more likely to match alerts (P < .0001). CONCLUSION/CONCLUSIONS:Apps like Citizen may provide earlier notification of traumatic events and therefore earlier mobilization of trauma service resources. Earlier notification may translate into improved patient outcomes. Additional studies into the benefit of apps for trauma care are warranted.
PMID: 34210527
ISSN: 1532-7361
CID: 4927182

Equity on the Frontlines of Trauma Surgery: An #EAST4ALL Roundtable

Tung, Lily; Long, Andrea M; Bonne, Stephanie; Tseng, Esther S; Bruns, Brandon; Joseph, Bellal; Williams, Brian H; Stein, Deborah; Freischlag, Julie A; Goulet, Nicole; Khandelwal, Cathleen; Kiselak, Elizabeth; Hoofnagle, Mark; Gelbard, Rondi; Rattan, Rishi; Joseph, D'Andrea; Bernard, Andrew; Zakrison, Tanya L
Inequity exists in surgical training and the workplace. The Eastern Association for the Surgery of Trauma Equity, Quality and Inclusion in Trauma Surgery Ad Hoc Task Force (EAST4ALL) sought to raise awareness and provide resources to combat these inequities.
PMID: 33009339
ISSN: 2163-0763
CID: 4640702

COVID-19, Ethics and Equity-What Is Our Role as Surgeons?

Zakrison, Tanya L; Martin, Matthew; Seamon, Mark; Matthews, Jeffrey; Joseph, Bellal; Rattan, Rishi; Mendoza, April; Bernard, Andrew; Gelbard, Rondi; Crandall, Marie; Punch, Laurie; Joseph, D'Andrea; Bonne, Stephanie; Mubang, Ronnie; McCunn, Maureen; Rogers, Selwyn; Turner, Patricia; Claridge, Jeffrey; Henry, Sharon; de Moya, Marc; Tseng, Esther; Goulet, Nicole; Tung, Lily; Kiselak, Elizabeth; Duncan, Thomas; Kaafarani, Haytham; Ferrada, Paula; Foster, Shannon; Ding, Linda; Santos, Ariel; Winfield, Robert D; Weaver, Jessica; Angelos, Peter
PMID: 32404670
ISSN: 1528-1140
CID: 4438152

Structure and function of a trauma intensive care unit: A report from the Trauma Intensive Care Unit Prevalence Project

Michetti, Christopher P; Fakhry, Samir M; Brasel, Karen; Martin, Niels D; Teicher, Erik J; Liu, Chang; Newcomb, Anna; Stewart, Amy; Chang, Grace; Foreman, Michael; Rainey, Evan Elizabeth; Moore, Forrest O; Huang, Jessica; Kaups, Krista; Dirks, Rachel C; Sensenig, Rachel L; San Roman, Janika L; Burlew, Clay Cothren; Campion, Eric M; Weireter, Len; Kelley, Katherine; Kim, Dennis; Howell, Erin; Hu, Charles; Lewandowski, Karen; Michetti, Christopher P; Liu, Chang; Teicher, Erik; Newcomb, Anna; Dauer, Elizabeth D; Mukherjee, Kaushik; Penaloza, Liz G; Cullinane, Daniel C; Carrick, Matthew M; Agrawal, Vaidehi; Lorenzo, Manuel; Ferrari-Light, Dana; Coomaraswamy, Michael; West, Michaela A; Farhat, Joseph; Brasel, Karen J; Ballou, Jessica H; Drumheller, Byron C; Radowsky, Jason; Dries, David J; Ramey, Elizabeth; Fakhry, Samir M; Goulet, Nicole; Livingston, David H; Meizoso, Jonathan P; Zakrison, Tanya L; Wahl, Wendy L; Brandt, Mary-Margaret; Nasrallah, Fady S; Schaffer, Kathryn B; Sakran, Joseph V; Kodadek, Lisa M; Cardenas, Tatiana C P; Rani, Meenakshi; Khan, Abid; Moskowitz, Elisa; Costantini, Todd W; Doucet, Jay J; Schroeppel, Thomas; Corey, Katherine; Pederson, Claire; Martin, Kevin H; Bosarge, Patrick L; Farley, Paige; Nahmias, Jeffry; Grigorian, Areg; Crandall, Marie; Mull, Jennifer; Efron, Philip A; Davis, Ruth; Berdel, Henrik; Culpepper, Chris; West, Sonlee D; Keiler-Green, Ashley; Martin, Niels D; Tung, Lily; Sperry, Jason L; Anto, Vincent P; Nirula, Ram; Buhavac, Milos; Dultz, Linda Ann; Podbielski, Jeanette; Kao, Lillian; Adams, Raeanna; Romero, Javier; Diaz, Graal; Bochicchio, Grant V; Rasane, Rohit K; Maung, Adrian A; Hill, Casey; Campbell, Andre; Bongiovanni, Tasce
BACKGROUND:Specialized trauma intensive care unit (TICU) care impacts patient outcomes. Few studies describe where and how TICU care is delivered. We performed an assessment of TICU structure and function at a sample of US trauma center TICUs. METHODS:This was a multicenter study in which participants supplied information about their trauma centers, staff, clinical protocols, processes of care, and study TICU (the ICU admitting the majority of trauma patients). RESULTS:Forty-five Level I trauma centers trauma centers enrolled through the American Association for the Surgery of Trauma multi-institutional trials platform; 71.1% had less than 750 beds and 55.5% treated 1,000 to 2,999 trauma activations/year. The median number of hospital ICU beds was 109 [66-185]. 46.7% were "closed" ICUs, 20% were "open," and 82.2% had mandatory intensivist consultation. 42.2% ICUs were classified as trauma (≥80% of patients were trauma), 46.7% surgical/trauma, and 11.1% medical-surgical. Trauma ICUs had a median 10 [7-12] intensivists. Intensivists were present 24 hours/day in 80% of TICUs. Centers reported a median of 8 (interquartile range [IQR], 6-10) full-time trauma surgeons, whose ICU duties comprised 25% (IQR, 20%-40%) of their clinical time and 20% (IQR, 20-33) of total work time. A median 16 (IQR, 12-23) ICU beds in use were staffed by 10 (IQR, 7-14) nurses. There was considerable variation in the number and type of protocols used and in diagnostic methods for ventilator-associated pneumonia. Daily patient care checklists were used by 80% of ICUs. While inclusion of families on rounds was performed in 91.1% of ICUs, patient- and family-centered support programs were less common. CONCLUSION:A study of structure and function of TICUs at a sample of Level I trauma centers revealed that presence of nontrauma patients was common, critical care is a significant component of trauma surgeons' professional practice, and significant variation exists in care delivery models and protocol use. Opportunities may exist to improve care through sharing of best practices. LEVEL OF EVIDENCE:Therapeutic/Care management, level IV.
PMID: 30741885
ISSN: 2163-0763
CID: 5093112