Decreasing hospital lengths of stay increases the burden on trauma patients after discharge. Our hypothesis was that a discharge callback protocol would decrease readmission rates. A retrospective quality improvement study evaluated all trauma patients admitted from 2012 to 2016 at a Level I trauma center. A postdischarge callback protocol was implemented in 2014, with a mature protocol in place in 2015. The precall and callback groups were compared regarding demographics, injury severity, and trauma readmission. Callback data included length of call, unsolicited patient comments, and education provided. Chi-square and Fisher's exact tests were used to compare categorical variables, whereas an independent-samples t test was used to compare continuous data. The precall program group included 4,470 admissions, and the call program group included 4,647 admissions. The precall program group had a higher injury severity score (ISS; 11.7 vs. 10.3; p < .001) and fewer males (62% vs. 65%, p = .002). In the call program group, there was a significant decrease in readmission rates (1.42% vs. 0.81%; p = .04). Patients with an unplanned readmission had a higher ISS (14.9 vs. 11.0, p < .01), a longer mean hospital length of stay during initial admission (9.3 days vs. 4.8 days, p < .01), and were more often discharged to locations with medical oversight (37.4% vs. 26.7%, p = .03). Of the patients in the call program group, 27.9% were reached. An average of 5.8 ± 2.9 min per call was calculated, equating to a 0.2 full-time equivalent. A discharge callback program for approximately 2,500 trauma patients per year leads to fewer readmissions, which financially supports the callback position.

Background: Prior studies suggest interprofessional teamwork training improves trauma resuscitation team performance and outcomes. This study explores whether additional improvements are observed with advanced trauma nurse training in comparison with prior interprofessional teamwork studies conducted in the same setting. Methods: This is a prospective, guasiexperimental preintervention and postintervention study incorporating TeamSTEPPS (R) with interprofessional simulations. Results: Trauma nurses' self-confidence in skills increased significantly in all areas after training (p < .05). Trauma resuscitation team performance improved significantly after training but degraded between 6 and 12 months after training. The greatest decline in performance over time was seen in the readership domain (p < .05). Conclusions: Study findings support prior studies, suggesting teamwork training improves team attitudes and performance. Interprofessional trauma resuscitation team training provided every 6 months may support sustained improvement gains over time. (C) 2019 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.

Limiting CT imaging in the ED has gained interest recently. After initial trauma workup for consultations in the ED, additional CT imaging is frequently ordered. We assessed the benefits of this additional imaging. Our hypothesis was that additional imaging in lower acuity trauma consults results in the diagnosis of new significant injuries with a change in treatment plan and increased Injury Severity Score (ISS). The registry at our Level I trauma center was queried from November 2015 to November 2016 for trauma consults initially evaluated by ED physicians. Patients with mild to moderate injuries were included. Injury findings before and after additional imaging were determined by chart review and pre- and postimaging ISS were calculated. Blinded trauma surgeons assessed the findings for clinical significance and changes in treatment. Four hundred and twenty-one patients were evaluated, 41 were excluded. One hundred and forty patients (37%) underwent additional CT imaging. Forty-seven patients (34%) had additional injuries found, with 16 (12%) increasing their ISS (mean 0.54, SD 1.66). Ninety-three per cent of cases resulted in at least one physician finding the new injuries clinically significant; however, agreement was low (κ = 0.095). For 70 per cent, at least one physician felt the findings warranted a change in treatment plan (κ = 0.405). Additional imaging in ED trauma consults resulted in the identification of new injuries in 1/3 of our patient sample. This suggests that current efforts to limit the use of CT imaging in trauma patients may result in significant injuries going undiscovered and undertreated. Further research is needed to determine the risk of attempts to limit imaging.