Evidence to Change Practice in Trauma Patients -- Time and CT Scans

Paper

Thursday, July 14, 2005

This presentation is part of : Acute Care Nursing

Marie C. Dieter, RN, PHRN¹, Cheryl Lansenderfer, RN, BSN, PHRN¹, Julie Albertson, RN, BSN, PHRN¹, Valerie Rupp, RN, BSN, PHRN², Rosemary Scheirer, RN, PHRN¹, Laurie Cartwright, RN, BSN, CRNI¹, Courtney B. Vose, RN, MSN, CRNP³, and Joanna Lynn Bokovoy, RN, DrPH, MPH⁴. (1) Emergency Department, Lehigh Valley Hospital & Health Network, Allentown, PA, USA, (2) Emergency Department Research, Lehigh Valley Hospital & Health Network, Allentown, PA, USA, (3) Emergency Services, Lehigh Valley Hospital & Health Network, Allentown, PA, USA, (4) Clinical Services Research, Lehigh Valley Hospital & Health Network, Allentown, PA, USA

Learning Objective #1: Identify five ways that CT scans provide vital information to support optimal treatment of the trauma patient
Learning Objective #2: Describe three methods to identify delays that can impact the diagnosis of life-threatening injuries in the trauma resuscitative process

Introduction. Trauma is the leading cause of preventable death between the ages of 1 and 44. With the evolution of the technology, Computer Axial Tomography Scans (CT Scans) have been proven to be an integral aspect of the initial trauma patient evaluation and quick CT Scans and results (<=30 minutes from patient arrival to final CT Scan results) are associated with the best trauma morbidity and mortality outcomes.

Methods. A convenience sample of 270 trauma patients requiring CT Scans were enrolled over a 4-month period, in a prospective, observational study aimed at quality improvement of the CT scan process. Data collected in the review process was time the scans were ordered, time of departure of the patient from the trauma bay and/or emergency department, time the scans were completed, and time the preliminary “wet” reads were received by the emergency department. A database was developed to collect data associated with the areas of greatest delays.

Results - Data were compared by two levels of trauma severity. Using Independent T-Test to compare times (in minutes), the more severe trauma patients were given their head CT scan reports more quickly after the scan (M = 138, SD 57) than the less-severe trauma patients (M = 181, SD 72), t(169) = 3.67, p = <.0001. There were no significant differences between groups for face, c-spine, chest or abdominal CT times. However, all times for each of the five types of CT scans were significantly higher than the ideal 30-minute time from CT scan to report (p <.0001), with means ranging from 88 to 202 minutes.

Conclusion – Previous research and this study data supported a need to improve times within the trauma CT scan process and a strategic initiative is being implemented by the core trauma team nurses and colleagues to improve those times.

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