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Area of Science:

  • Trauma Surgery
  • Healthcare Quality Improvement
  • Advanced Practice Providers

Background:

  • Benchmark data revealed higher-than-average intensive care unit (ICU) return rates and increased readmissions in our trauma program.
  • These findings indicated a need for continuous quality improvement initiatives to enhance patient care pathways.
  • The study focused on addressing these complications through workflow optimization.

Purpose of the Study:

  • To decrease unplanned return to ICU and hospital readmission rates for trauma patients.
  • To evaluate the impact of restructuring advanced practice provider (APP) workflows on patient outcomes.
  • To implement a comprehensive clinical care model for trauma patients.

Main Methods:

  • Extended APP daily shifts to match resident physician coverage.
  • Transitioned APP roles from task-oriented to comprehensive clinical care.
  • Involved APPs in ICU transfer decisions and implemented a standardized discharge process with follow-up calls.

Main Results:

  • The ICU readmission rate decreased from 5.7% in 2012 to 2.1% in 2014, falling below the TQIP national average.
  • Hospital readmission rates dropped from 2.0% in 2012 to 0.96% in 2014.
  • These improvements were observed after the implementation of the new APP workflow program.

Conclusions:

  • Implementing a comprehensive clinical care model for APPs and standardizing the discharge process significantly reduced unplanned ICU returns.
  • Hospital readmission rates were halved following the workflow restructuring.
  • The study demonstrates the effectiveness of APP-led quality improvement in trauma care.