traumaannualreport2013

2013 Trauma Annual Report Mercy Hospital and Trauma Center Offering trauma patients the best possible outcome ... a second chance at life

Messages Who we are Our trauma team MD-1 in the field Trauma defined Mercy trauma statistics: 2013 Quality improvement Sexual trauma Hospital-based services Preventing injury

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Trauma center messages From the president According to the Centers for Disease Control, injury is the leading cause of death for Americans 44 years of age and younger. As the only Level II trauma center in south-central Wisconsin, Mercy Hospital and Trauma Center is helping reduce the rates of disability and death associated with injury.

Our multi-disciplinary team of certified trauma surgeons and nurses, emergency medicine physicians, neurosurgeons, orthopaedic surgeons, ENTs, heart and vascular surgeons, plastic and reconstructive surgeons, anesthesiologists and other specialists and staff provide leading-edge care to severely injured patients. See page 3 for a full listing of the many disciplines that comprise our trauma team.

As a Level II trauma center, we are committed to providing the necessary resources to meet the needs of our community, and we are making a difference. In 2013, Mercy gave more than 800 trauma patients a second chance at life. This commitment and dedication will continue into the future for the good of all of our patients.

This 2013 annual report allows us to highlight some of the things Mercy is doing to revolutionize critical care for the residents across our region. Thank you for supporting us on our journey.

Regards, Javon R. Bea, President/CEO, Mercy Health System

From the trauma medical director It is an honor and privilege to be part of developing Mercy’s emergency services into a Regional ACS (American College of Surgeons) Verified Level II Trauma Center with acute care surgical services, a Joint Commission Verified Primary Stroke Center; and a Society of Chest Pain Centers Accredited Chest Pain Center. These services have made critical, intensive and specialty services available to our patients close to home at our community hospital.

The growth and refinement of these services decreased trauma patients transferred to other trauma centers from 20% in 2008 to 4% in 2013. The most critical patients are able to stay in our community from the time when EMS and MD-1 physicians respond to events and bring patients to our state-of-the-art emergency department, operating rooms and intensive care unit. They continue to receive excellent care through their rehabilitation in our Comprehensive Inpatient Rehabilitation unit, and follow-up in our clinics and with their own Mercy primary care doctors. The positive impact these services have made on our patients and their families is substantial.

Our team of medical experts provides exceptional services and care to our neighbors in need. Countless staff and ancillary personnel also ensure they meet the best possible outcome. Our colleagues include paramedics, local emergency volunteers, referring facilities, nurses, laboratory personnel, respiratory therapists, medical imaging staff, physical/occupational therapists, speech pathologists, dietitians, social workers, case managers, palliative care nurses and chaplains.

We strive to provide the best care possible to all patients who present to our trauma center. This annual report describes our 2013 efforts in achieving that goal. Our thanks go again to the many trauma care providers at Mercy Hospital and Trauma Center and across our region who work hard every day to care for the injured.

Wishing you good health, Robb Whinney, DO, Medical director, Mercy Hospital and Trauma Center trauma department 1

Who we are

At Mercy Hospital and Trauma Center, we offer critically injured patients immediate, life-saving care close to home, 24 hours a day, seven days a week, 365 days a year, and continue to care for most injured patients through their entire course of hospital care and rehabilitation.

Our mission To reduce regional trauma-related death and disability by providing seamless care resulting in healing in the broadest sense.

Our vision We are committed to provide: • Regional trauma leadership • Community injury prevention education • Education to those who care for the injured • The highest quality care through continuous performance improvement

Our trauma services go well beyond the emergency department. Mercy’s multi-disciplinary trauma and critical care team is ready at a moment’s notice to care for the most severely injured patients. Everything is in place upon the patient’s arrival: doctors, surgeons, nurses, imaging equipment, operating rooms and support staff.

Mercy Hospital and Trauma Center is the only Level II Trauma Center south of La Crosse as verified by the American College of Surgeons Committee on Trauma.

We treat more than 800 trauma patients annually.

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Our full hospital trauma team includes:

Our trauma team Medical providers • Robb Whinney, DO, FACOS, medical director, trauma and acute care surgery • Alissa DeVos, PA-C, trauma and acute care surgery • Krista Kimball, PA-C, trauma and acute care surgery • Derek Wall, MD, trauma and acute surgery • Patricia Garner, MD, general surgery • Ancil Philip, MD, general surgery

Program staff • Anne Quaerna, RN, MSN, director of ED, EMS and trauma • Lori McKibben, RN, BSN, MBA, trauma program coordinator • Terry Michel, injury prevention coordinator • Barbara Hermening, RN, trauma registrar • Diane Eppihimer, RN, trauma and acute care clinic • Kate Ayers, CMA, trauma and acute care clinic We work closely with local emergency responders, surrounding hospitals and trauma centers to give our trauma patients rapid, high-quality care.

Mercy also addresses secondary trauma—the effects that the injured individual’s loved ones must deal with.

Our chaplains, social workers and care coordinators are here to gently guide patients and families from the initial injury through the entire hospital and recovery phase.

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Emergency doctors and nurses

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Trauma surgeons and nurses

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Neurosurgeons

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Cardiothoracic surgeons

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Orthopaedic surgeons

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Vascular surgeons

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Ear, nose and throat surgeons

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Plastic and reconstructive surgeons

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Ophthalmologists

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Anesthesiologists

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Radiologists/interventional radiologists

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Critical care specialists

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Hospitalists

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Chaplains

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Laboratory and blood bank technicians

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Diagnostic imaging technicians

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Inpatient nursing staff

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Respiratory therapists

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Social services staff

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Dietitians

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Palliative care specialists

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Inpatient and outpatient rehabilitation staff

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Trauma clinic follow-up care staff

Mercy’s MD-1 brings physicians to emergencies

Pictured (L-R): Dr. Jay MacNeal, Dr. Christopher Wistrom, Dr. Sean Marquis and Dr. Todd Daniello.

MD-1 is a first for Rock County and one of only a few in the nation. This medically equipped and emergency medicine physician-staffed Chevy Tahoe is based at Mercy Hospital and Trauma Center. MD-1 is used for difficult and prolonged extrications or situations where an on-the-scene physician may be able to provide additional medications and resources.

using physician-authorized protocols. Mercy’s MD-1 program is designed to augment, not replace, existing community EMS resources in the community. When EMS crews feel it is appropriate and necessary, Mercy EMS physicians will respond in MD-1 to their request any time, day or night.

MD-1 has responded to over 250 calls since inception in 2012. In August 2014, we added an MD-1 vehicle to our Walworth County service area.

EMTs and paramedics are equipped and trained to handle a vast array of emergency medical conditions

MD-1 physicians (pictured above) • Jay MacNeal, DO, MPH, NREMT-P, EMS medical director • Christopher Wistrom, DO, NREMT-P, associate EMS medical director • Todd Daniello, MD, NREMT-P, associate EMS medical director • Sean Marquis, MD, NREMT-P, associate EMS medical director

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Trauma defined According to the American Trauma Society, trauma is a severe blunt or penetrating injury primarily caused by automobile crashes, gunshots, knife wounds, falls, battery or burns. The Centers for Disease Control’s (CDC) field trauma triage guidelines recommend trauma centers for these types of patients because of improved outcomes. The CDC rates injury as the leading cause of death for American children and adults ages one to 44.

Level II trauma care These facilities have resources available 24/7 to care for the majority of injured patients. Key elements include 24-hour coverage by general surgeons and prompt availability of care in varying specialties such as orthopaedic surgery, neurosurgery, plastic surgery, anesthesiology, emergency medicine, radiology, internal medicine, oral and maxillofacial surgery, otolaryngology and critical care, which are needed to adequately respond and care for various forms of trauma that a patient may suffer.

Minor injuries can also be treated at a trauma center, and will typically be handled by an emergency medicine physician with backup from other medical specialists.

Level II facilities accept patients transferred from Level III and Level IV facilities. In addition, Level II facilities take part in community injury prevention and outreach education initiatives, and are involved with local and state government issues related to trauma care and prevention.

Level I trauma care Patients who require certain sub-specialties may be transferred to a Level I trauma center, including University of Wisconsin Hospital and Clinics in Madison and Froedtert Hospital in Milwaukee. These facilities are equipped to accept: • Critical burn patients who meet burn center criteria • Critical pediatric (younger than 15) patients who require intensive care monitoring • Complex pelvic fracture patients who require trauma-trained orthopaedic surgeons • Amputations with the possibility of re-implantation

Level III trauma care These facilities, often community hospitals, generally have resources available to treat and stabilize the majority of injured patients, however, these resources may not be available 24/7.

Level IV trauma care This is available at settings such as urgent care centers and physician clinics. Minimal resources are available, but they have procedures in place to immediately transfer injured patients to a higher level of care.

In addition to Level II criteria, Level I trauma centers also provide emergency and surgical residency programs and participate in trauma-related research activities.

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Mercy Hospital and Trauma Center statistics: 2013 Trauma patients

Discharged from ED 100 87%

ED response: 10% No activation: 45%

80

57%

60 Modified: 34%

40%

20% 1% Full: 11%

0% Full

Modified

ED

Full

Potential life-threatening injuries; may require immediate surgical intervention Modified Significant mechanism of injury, stable injuries; may require surgical consult ED response Minor mechanism of injury, minor injuries; usually does not require surgical consult

Mechanism of injury Motorcycle: 5%

Injury severity score (ISS)

Stabbing: 1% Firearm: 1%

Pedestrian: 2% Other: 11% 9-15: 22%

16-24: 4% 1-8: 71%

25-40: 2% >41: 1%

Fall: 42%

Motor vehicle: 38%

ISS is an established medical score to assess trauma/injury severity. It correlates with mortality, morbidity and hospital length of stay. The higher the ISS, the more severely injured the patient, with a score of 15 or greater defining a major trauma patient.

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patient disposition mechanism Mercy Hospital and Trauma Center statistics: 2013 mode of arrival

Mode of arrival Per own vehicle: 21% Helicopter: 6%

Ground basic life support: 23%

EMS agency 6% Beloit Ground advanced life support: 50% 8% Milton 1% Clinton 4% Edgerton 1% Orfordville 3% Footville 1% Town of Beloit 2% Paratech mechanism 2% Whitewater

patient disposition

Patient disposition

4% Evansville 2% Brodhead

Discharged from ED: 26%

Transfer out: 4%

7% other

Deaths: 2%

Janesville 56%

We see our EMS partners as an invaluable extension of the exceptional trauma care our patients receive in the hospital. Improvedems outcomes agency for trauma patients are closely linked to adequate early resuscitation and timely transfer of appropriate patients to trauma centers (WI State Trauma Triage and Transfer Guideline). Studies show that the sooner a trauma patient can get to definitive care, the better their outcome.

age injury severity

Admits: 68%

100

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Age

Gender

15-55 yrs: 53%

59%

>55 yrs: 39%

41%

<15 yrs: 8%

gender

age

ems agency

Average length of stay 6 5 days

5

100

4 3 days

3

80

2

60

1

40% 0 ICU

20% 0%

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Hospital

Continually improving our quality

Lori McKibben, RN, BSN, MBA, trauma program coordinator

action and reevaluation, care is directly improved at the bedside, throughout the system and within the region.

The hallmark of any trauma center is a continuous process of measurement, assessment and management directed at improving patient care.

Our goal is to build a trauma system that coordinates the efforts of all team members to improve the outcomes of traumatically injured patients in our region.

Pre-hospital providers should strive for a scene time less than 20 minutes. Referral hospitals should aim to transfer patients within 3 hours. Tertiary facilities must strive to quickly and thoroughly assess the patient and provide life-saving interventions.

We strive to continually make the changes that will lead to better patient outcomes, better system performance and better professional development.

The process of performance improvement reviews the entire continuum of patient care, from the initial scene response through acute care, rehabilitation and reintegration back into the community. Performance improvement is data-driven and outcomes-focused.

Through data measurement, issue identification,

Our ultimate goal is to improve the care being given to patients as a means to reduce their morbidity and mortality. In 2013, Mercy Hospital and Trauma Center trauma patients had a mortality rate of only 2%.

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Sexual trauma

Jackie Friar-LeCaptain, RN, SANE program coordinator When a person’s traumatic injuries are caused by sexual assault, Mercy Hospital and Trauma Center offers round-the-clock compassionate care through its SANE (sexual assault nurse examiner) program. Mercy’s SANE program, the only one of its kind in Rock County, provides comprehensive care for sexual assault victims of all ages.

Mercy’s sexual assault nurse examiner is a registered nurse who has specialized education and has fulfilled clinical requirements to perform forensic examinations of patients who report sexual assault. She offers: • Full attention focused on the care and comfort of the patient • Emergency health services • Expertise to offer effective courtroom testimony • Definitions of consent and sexual assault • Community education about preventing sexual abuse • Access to important local resources Mercy Hospital and Trauma Center expanded its emergency services to include a SANE program in July 2008 to give Rock County the necessary services and the support it needs to care for victims of sexual assault. Since then, we have cared for 864 sexual assault patients.

For details about Mercy’s SANE program, call (608) 756-6522.

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Certified Primary Stroke Center Primary Stroke Center improves outcomes Nichelle Jensen, BSN, RN, CCRN, stroke program coordinator Mercy Hospital and Trauma Center has advanced certification as a Primary Stroke Center by the Joint Commission. Mercy is the first and only hospital in the area to receive this level of certification.

We have a full team of experts dedicated to caring for people who are having or have had a stroke. Our initial Code Stroke services include fast diagnosis and treatment. Our gold standard of treatment is administering a clot-busting drug—for those who qualify—within 60 minutes of arrival. The national rate of thrombolytic therapy for ischemic stroke patients is 6%. In 2013, Mercy’s thrombolytic therapy rate was 10%.

This shows Mercy’s commitment to aggressive stroke therapy.

We also offer complete inpatient and outpatient rehabilitation services, plus a stroke survivors’ support group. Mercy Hospital and Trauma Center has a declared and established commitment for acute stroke care.

Our Stroke Center resources These are the major areas that Mercy Hospital and Trauma Center was required to have to become a certified Primary Stroke Center: • • • • • • • • •

A 24-hour acute stroke team, including neurology, ED, and critical care physicians and nurses 24-hour access to a neurosurgical surgeon and neurosurgical services CT or MRI available 24/7 Rapid assessment of priority labs and CT/MRI scans for acute stroke patients Designated stroke units with specially trained staff Written tPA protocol in the ED and inpatient units Written acute stroke clinical pathways (detailed, evidence-based care plans) Regular stroke education sessions for all stroke staff Long-term follow-up for stroke treatment outcomes and quality improvement

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Accredited Chest Pain Center

Heart care at its best Laura Kingsbury, RN, BSN, TNS, chest pain program coordinator Chest Pain Center — As an accredited chest pain center, Mercy Hospital and Trauma Center has resources fully in place to reduce the time from the onset of a person’s heart attack symptoms to diagnosis and treatment. We treat patients faster during the critical window of time when the heart muscle can be preserved.

Code STEMI — STEMI is an abbreviation for ST-elevation myocardial infarction. It’s a severe heart attack caused by a prolonged period of blocked blood supply to a large area of the heart. Mercy’s Code STEMI team assesses, treats and supports these patients as fast as possible because crucial minutes are at stake. The national standard for STEMI treatment is 90 minutes. In 2011, Mercy’s average was 49 minutes. When time is muscle, it is important to open the obstructed cardiac vessel as soon as possible.

Through the use of 12-lead, pre-hospital EKGs, our heart catheterization lab times are better than the national average. Our state-of-the-art monitoring watches patients when it is not certain they are having a heart attack; this means they are not sent home too quickly and we are sure they receive the best treatment for their condition.

For recovery from a heart attack or heart surgery, our cardiopulmonary rehabilitation programs helps patients return to a healthier quality of life.

Our cardiac resources • • • • • • • •

Receiving station for EMS 12-lead EKGs Immediate notification of cardiology for STEMI 24/7 cardiac catheterization lab Cardiothoracic surgery Therapeutic hypothermia, which greatly improves both ROSC and neurologic outcomes of cardiac arrest patients Rapid laboratory response to STEMI patients Bedside digital x-ray for STEMI patients Emergency pacemaker placement

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Preventing injury Terry Michel, injury prevention coordinator

Distracted Driver Pledge In the US, unintentional traffic accidents are the leading cause of death in individuals aged one to 34.

Increasingly, accidents are caused by distracted drivers.

All distractions endanger driver, passenger, and bystander safety. These types of distractions include: • Texting • Using a cell phone or smartphone • Eating and drinking • Talking to passengers • Grooming • Reading, including maps • Using a navigation system • Watching a video • Adjusting a radio, CD player or MP3 player

Because our mission is to reduce regional trauma-related death and disability, Mercy Hospital and Trauma Center is committed to injury prevention through many community outreach initiatives.

ThinkFirst This nationwide, award-winning, evidence-based program teaches young people how to avoid or reduce their chances of being injured. Mercy implemented the ThinkFirst program as part of its trauma education initiative.

Our ThinkFirst coordinators provide education for third- and fourth-grade students in Rock County and surrounding areas. They visit schools to teach kids about the importance of thinking first to stay safe in any activity. Our program features Street Smart, Mercy’s popular mascot and safety superhero. We provided 91 ThinkFirst programs in 2013, reaching over 1,800 local school children.

Our Distracted Driver Pledge can be found at http://goo.gl/WeYzrp. Print it and share it with your loved ones.

Driver Assessment Program Mercy designed this program to determine a person’s ability to drive safely, whether they’re recovering from an illness or injury or are simply concerned about how aging has affected their driving skills. In the past year, Mercy occupational therapists completed 18 driver assessments.

To learn more, call our ThinkFirst coordinators at (608) 743-2060.

Concussion services Even when it’s mild, a concussion can be a real brain injury that requires medical attention to prevent further problems. Project ImPACT is part of a national concussion screening and follow-up program Mercy offers to schools and head trauma patients. In the past year, Mercy has performed 203 baseline tests and 121 post-injury assessments.

The program is headquartered at the Mercy Occupational Conditioning Center in Janesville. To learn more, call (608) 755-7998.

CPR and first aid classes for the public can be scheduled through our Mercy Regional Emergency Medical Services Training Centers in Janesville and Lake Geneva. For more information, call Janesville at (608) 756-6182 or Lake Geneva at (262) 245-2195.

To learn more, call Mercy Sports Medicine and Rehabilitation Center in Janesville at (608) 754-6000.

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Street Smart supporting our communities

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Doing whatever it takes to see you well.