February 2023 - Trauma Nursing

February 2023
EAST Monthly Literature Review

"Keeping You Up-to-Date with Current Literature"
Brought to you by the EAST Manuscript and Literature Review Committee

This issue was prepared by Society of Trauma Nurses Susan Cronn, DNP, RN, Melissa Wholeben, PhD, RN and Colleen Trevino, PhD.


Thank you to Haemonetics for supporting the EAST Monthly Literature Review.


In This Issue: Trauma Nursing

Scroll down to see summaries of these articles

Article 1 reviewed by Susan Cronn, DNP, RN
Impact of COVID-19 on U.S. hospital-based injury prevention professionals: A national survey. Edwards C, Arabian SS, Colburn-Hargis P, Duchossois G, Adams C. Journal of Trauma Nursing. 2023 Jan-Feb;30(1):20-26.

Article 2 reviewed by  Melissa Wholeben, PhD, RN
Trauma and death in the emergency department: A time to PAUSE (Promoting Acknowledgment, Unity, and Sympathy at the End of Life). Welch AA, Esquibel BM, Osterloth KA, Kallies KJ, Fitzsimmons AJ, Waller CJ. Journal of Trauma Nursing. 2022 Nov-Dec;29(6):291-297.

Article 3 reviewed by Colleen Trevino, PhD
Rate of Nonsurgical Admissions at a Level 1 Trauma Center: Impact of a Trauma Nurse Practitioner Model. Hardway J, Samanta D, Evans KJ, Bethea A. J Trauma Nursing. 2020 May/Jun;27(3):163-169.


Article 1
Impact of COVID-19 on U.S. hospital-based injury prevention professionals: A national survey. Edwards C, Arabian SS, Colburn-Hargis P, Duchossois G, Adams C. Journal of Trauma Nursing. 2023 Jan-Feb;30(1):20-26.

The multiple waves of SARS-CoV-2 had tremendous impact on US healthcare, which hospitals attenuated through reallocation of personnel, restructuring of service delivery, and prioritizing resources into support for increasing numbers of ill patients. As the pandemic continued through the next two years, hospitals remained under stress due to ongoing COVID-19 patient needs, limited resources, and increases in violent injuries. Despite clear need for focused interventions for injury prevention and response to escalating violence, these programs experienced loss of personnel and reductions in capacity, up to and including program suspension. Safe States Alliance data shows that hospital and injury prevention specialists reported 87% of programs, training, and assistance were negatively impacted by the pandemic. This study used descriptive cross-sectional survey of hospital-based injury prevention professionals to self-report on the state of three domains: (1) trauma center profile; (2) hospital-based injury professional position/licensure; and (3) impact of COVID-19 on job duties, position, and injury prevention program (IPP). From a total of 216 individuals from 227 trauma centers across the US, most IP professionals reported a change in job duties, position, and IP capacity, resulting in an overall reduction in IP efforts in the US. The most notable impacts to IP professionals included furloughing positions, shifting to clinical role, working from home, transitioning to virtual delivery of programming, and suspension of IPP. Despite the mandate of the ACS COT that level I and II trauma centers have IP activities/programming and personnel (either separate or combined roles), 26% of IP professionals employed by level I trauma centers prior to COVID-19 were furloughed and 4% were eliminated. IPP at adult-only or combined adult-pediatric trauma centers had higher odds of suspension than pediatric-only trauma centers (OR 3.6). No significant differences were found across trauma verification levels. RN respondents were reassigned to clinical duties at a rate of 63%, compared with 10% of non-licensed respondents.
 
This study demonstrates that organizational commitment to supporting the work of injury prevention programs is not adequate. IPPs are underfunded, understaffed, and lack opportunities for professional development. Successful implementation of IPPs is related to supportive institutional leadership and collaborative multi-departmental relationships, but this has not been found to be the norm in other analyses of IPPs. The added strain of the pandemic highlighted the under-prioritization of IPPs. Though optimal care of the trauma patient requires a resourced, public-health focused arm of trauma centers, IPPs bore a large burden of pandemic-related reallocation of resources. The implications of this study may be significant for prioritization and planning for maintenance of IPPs under difficult conditions. The limitations of the study include potential bias in both survey development and response, as well as purposive sampling, which did not allow for contacting and engaging those IP professionals who left the role prior to the survey, thus underrepresenting their experience of the pandemic strain on IPPs. Despite these limitations, the study paints a compelling picture of the breakdown of critical programming at a time of increased need for patients and populations served by trauma centers.

Article 2
Trauma and death in the emergency department: A time to PAUSE (Promoting Acknowledgment, Unity, and Sympathy at the End of Life). Welch AA, Esquibel BM, Osterloth KA, Kallies KJ, Fitzsimmons AJ, Waller CJ. Journal of Trauma Nursing. 2022 Nov-Dec;29(6):291-297.

Trauma activations are a typical element of the daily operations of an emergency room. These activations can be extremely demanding and intense, with healthcare providers within the Emergency Department working to save the patient. In some instances, the trauma is fatal, and the patient does not survive. Due to the severity of other trauma patients within the emergency department, there is no time for emergency department personnel to have closure. This condition has become one of the factors connected with health care worker burnout (Welch, et al., 2022).

The purpose of this pre-and post-intervention study was to examine the impact of a trauma PAUSE on the attitudes of trauma team members following the death of an emergency department patient. The research team created a brief Trauma PAUSE (Promoting Acknowledgment, Unity, and Sympathy at the End of Life) intervention. This intervention reflected a non-denominational perspective on religious customs and beliefs. After announcing the time of death, the trauma surgeon/physician would commence the PAUSE and make a brief speech to honor the patient and the trauma crew. The hospital chaplain would then lead a moment of silence and a scripted statement honoring the deceased and the trauma team's efforts.

The study spanned two years, with the initial survey analyzing participants' perspectives on trauma-related mortality in this demographic. After two years of implementing the trauma PAUSE intervention, a post-survey was administered with six additional questions regarding the participants' perceptions of the intervention's implementation. Analyses were conducted on two subgroups: those who had participated in a PAUSE and those who had not.

Participants in the Trauma PAUSE program reported an increase in their ability to find serenity following a trauma code, an improvement in their resilience, and the ability to shift to their next emergency department task. Additionally, other departments have recognized the importance of this healthcare professional tool by utilizing it in the ICU, COVID-19 units, and with first responders in the field.

Article 3
Rate of Nonsurgical Admissions at a Level 1 Trauma Center: Impact of a Trauma Nurse Practitioner Model. Hardway J, Samanta D, Evans KJ, Bethea A. J Trauma Nursing. 2020 May/Jun;27(3):163-169.

The American College of Surgeons (ACS) mandates all trauma centers conduct individual case reviews of nonsurgical admissions when rates exceed 10% of all inpatient traumas. Nonsurgical admission rates at the study institution exceeded 20%. These rates led to the inception of a trauma nurse practitioner (TNP) inpatient management model for non-surgical admissions. Morbidity and mortality outcomes were compared in trauma patients admitted under the TNP versus hospitalist services.

This is a single center retrospective cohort study conducted at a Level I trauma center. There were 749 patients admitted to the TNP group and 651 to the hospitalist group during the study period. Patients in the TNP group were significantly younger and more likely to be male than those in the hospitalist group. The average number of preexisting conditions was significantly lower in patients under the care of TNPs. However, the average number of injuries present upon admission and the proportion of patients requiring surgical were significantly higher for the TNP group. The duration of hospital LOS was significantly lower for patients under the care of TNPs which translated into a decrease in hospital charges of approximately $876,330 for the study period. Trauma nurse practitioners also discharged a significantly higher proportion of their patients home. Time to OR was significantly shorter in the TNP cohort. In-hospital mortality and 30-day readmission did not differ significantly between the two groups. There was only one patient in the study with reported missed injuries; this patient was managed by the hospitalist service.
 
Existing literature supports the role of TNPs related to positive patient outcomes including hospital LOS, ICU LOS, time to place rehabilitation consult, missed injuries, and hospital charges. Although the study institution had not met the ACS criteria of less than 10% of nonsurgical admissions, they reduced non-surgical admissions by half (26.8% to 13.9%). Success of the role was attributed to improved TNP autonomy and trauma specialty specific training. Expansion of TNP services to older patients with comorbidities is warranted.