Trauma Awareness Month and vRad’s Impact

As I mentioned in my last post, May is both Trauma and Stroke Awareness month. vRad serves hundreds of trauma and stroke centers across the U.S.  The intention of this blog series is to provide a behind-the-scenes look into our process for triaging stroke and trauma studies and relaying critical findings. 

 This is the second in the 3 post series:

1. Stroke information and our impact;
2. Trauma information and our impact;
3. Critical relay times and the future of stroke and trauma treatment.

Today, let’s talk about Trauma Patients.

Established in 1988 by President Ronald Reagan, May is National Trauma Awareness month; this May is the 29^th anniversary of the nationwide StopTheBleed campaign, which works to educate and empower individuals to act in an emergency situation to StopTheBleed – and help protect lives before first responders arrive.

For our part, vRad is proud to provide emergency radiology services to hospitals across the county—in fact, we provide service to approximately 30 percent of hospitals in the United States. Similar to stroke exams, when a trauma occurs, there’s a good chance a vRad radiologist is reading those studies – especially during the night or wee hours of the morning.

We are ALL patients at some point, but many of us have the luxury of knowing “when” our next appointment is.  The same is not true for trauma patients whom, by definition, experience an acute injury.

Let’s Elaborate: What is a Trauma Patient?

Trauma patients experience an acute traumatic, and many times life-threatening, event that requires immediate medical attention.

The majority of trauma patients have experienced a recent Motor Vehicle Accident (MVA), Gun Shot Wound (GSW), Fall (down steps or in-home injury) or general accidents involving tools or machinery.

Frequently, a trauma patient is entering the hospital after a 911-call or an accident in which the patient was found unresponsive.  This can result in patient names such as “Trauma, John”, “Trauma, Female” or other generic patient description. This is a way for the hospital to quickly flag both the underlying urgency and the fact that they are unable to gain basic information from the patient due to their current status.

Given the challenge of communication or uncertainty regarding the extent of the patient’s injuries, trauma patients commonly receive multi-study imaging (Head-to-Toe if necessary).  Directly following this imaging, rapid diagnostic interpretations are critical so life-saving measures can be taken.

Improving the vRad Trauma Protocol.

In early 2014, with the help of our medical leadership team we evaluated our Trauma workflow and identified a few key areas to focus on:

1. Urgency: We had no clear and easy way for our clients to communicate “trauma” status (we offered STAT, Emergent and Stroke urgencies). Our clients were designating Trauma cases as Stat Emergent and calling our Operations Center to identify it as a Trauma.
2. Prioritization: Without having clear trauma communication (unless the facility reached out proactively), designating a study as Stat Emergent escalated the case above Emergent, but not as high as Stroke Protocol. Our medical leadership team determined Trauma and Stroke should receive the same level of prioritization.
3. Save-and-Hold Status: Once a Radiologist opened the first exam, we would immediately “Save” ALL of the additional trauma imaging for the same patient to the same radiologist, which could lengthen the read time depending on the extent of imaging that was performed.

Save-and-Hold Status [3] – Bundling Studies for Continuity of Care.

I’d like to elaborate a bit more on our Save-and-Hold feature.  We leverage an automated “Save-and-Hold” feature that proactively “Holds” all imaging for a single patient to the original reading radiologist.  This helps to create a continuity of care in the event our radiologist needs to call multiple findings to the referring physician, requests follow-up imaging to be performed or the patient has an extensive record of prior exams to review.

Proactively holding exams for a single patient for the same vRad radiologist helps to create a consistent experience and can save everyone time (including the patient) and most importantly, results in better patient care.

This is a critical feature in how we deliver patient care for all non-trauma patients, but it was presenting a unique challenge as it related to our Trauma studies where every minute can make a difference.

Our Solution: Trauma Protocol, Unbundling.

Based on this evaluation and discussion with internal and external medical staff, we developed our Trauma Protocol study urgency which enables our clients to designate trauma cases with distinct prioritization and turnaround times.

New Urgency & Prioritization [1 & 2]:

• Trauma studies are designated as a Trauma Protocol and assigned the highest urgency, equivalent to the same urgency as Stroke.
• The study is automatically escalated to the top of ALL available radiologists’ worklists with a requirement to be read next.

Updating Save-and-Hold [3] Status: The Trauma Protocol urgency bypasses our Save and Hold process and triggers our study unbundling workflow.

If: Urgency = “Trauma”

• Then: “unbundle” cases that include multiple body segments and assigns them to multiple radiologists to be read concurrently for faster turnaround time and patient care. The images are split based on the following body regions:
  • Neuro: head, face, orbits, cervical spine, and neck
  • Body: chest, abdomen and pelvis, thoracic and lumbar spine
  • Upper and lower extremities

• Radiology reports for each body region are sent as soon as they are completed, allowing treatment to begin as quickly as possible.

As a result of the changes we made to our Trauma workflow, we have improved our average Trauma study turnaround times by 40 percent (turnaround time statistic compares cases designated as trauma protocol following launch of the vRad Trauma Protocol to comparable cases for the 12-month period prior to launch).

2016 Trauma Protocol Performance Highlights

• vRad Completed: 224,290 Trauma Protocol Studies
  • ~18,691 Trauma Protocols per Month
  • ~613 Trauma Protocol patient studies per Day
• Average turnaround time (TAT) = 11.34mins

I hope you found this look into our Trauma protocols insightful. Later this month we’ll discuss the future of stroke and trauma care and critical relay times.

Joe Schmugge

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