Reducing Unnecessary Admission in Trauma

Grant Application

Matthew R. Rosengart, MD, UPMC Presbyterian, in partnership with Brian S. Zuckerbraun, MD, and Andrew B. Peitzman, MD

Proposed Innovation

Our aging population, increased rates of chronic disease, and other factors have created an overwhelming demand for acute care hospital beds. Unnecessary admissions and delays in discharge continue to burden already strained resources.

Patients who have sustained blunt trauma often are admitted for observation and examination, despite having normal CT scans. Through this project, a protocol was used to safely triage and discharge patients who have not sustained significant injury. The goal was to reduce unnecessary admissions and increase the availability of beds for acutely ill patients.

Improvements

The project team conducted a three-part experiment to test their theory that a protocol based on normal CT imaging — in combination with normal physiology and biochemical analysis — can be used to safely identify and discharge blunt trauma patients who have sustained no significant injury.

Initially, the team analyzed records of all blunt trauma patients aged 17 and older who were admitted to UPMC Presbyterian and underwent a CT scan of the head, neck, chest, and abdomen/pelvis to determine the need for hospitalization. During the second phase, the team analyzed trauma patients admitted for observation and provided follow up with the Trauma Clinic two weeks after discharge to determine the incidence of delayed injury. In the final phase, trauma patients meeting the established criteria — and who lived less than 10 miles from UPMC Presbyterian — were discharged without hospitalization. A research nurse contacted patients the day following discharge to check on their wellbeing, and follow-up care with the Trauma Clinic was provided two weeks after discharge.

Outcomes

The initial evaluation of more than 4,000 patients enabled the team to create a trauma protocol — or discharge guide — to accurately identify patients with underlying injuries. The follow-up study with 500 patients validated those findings and the trauma protocol was broadly implemented. Although initial compliance was low (28%), a grassroots effort led to more widespread acceptance and application of the guide. By March 2015, compliance had reached 81.8%, reducing unnecessary admissions and providing an additional 200 to 300 beds for acutely ill patients.