Raising the game

Published On 03/24/2014

ACS verification helps trauma team reach an underserved population

A push to “raise the game” in pediatric trauma care for Memphis children is helping kids in the most unexpected places – pockets of the rural South where the specialized care was once limited.

In 2011, Le Bonheur began pursuing and later attained American College of Surgeons (ACS) Level 1 pediatric trauma verification, which has translated into a region better prepared for pediatric emergencies.

“Not only did it set us on par with every other pediatric trauma center, it made us raise our game,” said Medical Director of Trauma Services James “Trey” Eubanks, MD.

Le Bonheur has long cared for local children who’ve been in car and ATV accidents, injured on the playing field or burned in house fires. The hospital is designated as a pediatric trauma center in Tennessee, Arkansas and Mississippi. Pursuing ACS verification took the hospital a step further out into the region.

Trauma patient volumes increase 60 percent in four years.“Though we geographically sit in a large urban city, we are surrounded by a predominately rural and underserved region,” said Le Bonheur President and CEO Meri Armour. “We found that the medical professionals in these areas are equipped to care for adults, not to provide the specialized pediatric care children who have experienced trauma require.”

As Eubanks’ team began the ACS verification process, the hospital implemented major changes. Today, anesthesiology is in-house 24/7, and the Emergency Department and operating rooms have specialized refrigerators that provide immediate access to blood products. Efforts are better coordinated throughout the hospital – from the moment the patient arrives in the Emergency Department to CT scan to OR to inpatient room. Indirectly, these changes improve the care for children across the hospital.

Watch Josiah's storyAnother byproduct of raising the level of care has been a 60 percent increase in trauma patient volumes.

“Most of those patients we find are coming from those underserved areas and rural communities that don’t have as many physicians or emergency rooms and may not even have a nearby hospital. So I think we’ve done that part of the community a great service,” Eubanks said.

The team is also making efforts to share its expertise. Outside the hospital, Eubanks’ team is on the road educating emergency room and operating room staff and EMS professionals on topics like how to resuscitate a badly injured patient and techniques for treating minor burns. Part of that training is understanding the level of care each child needs and getting those kids to the best place as soon as possible.

“That first hour after a trauma is the most important. And getting them here as quickly as possible is vital to improving quality and outcomes,” Eubanks said.

Le Bonheur educators work with 28 adult facilities in the region providing mock codes, following up with training after a patient has been transferred and simply being a 24-hour resource.

“I have training in adults and trauma, but I’ve never worked with as many kids as I do now,” said Delta Medical Emergency Department Head Nurse and Educator Jennifer Keith, RN. “The training from Le Bonheur has given us peace of mind. And peace of mind makes us better nurses because we’re not scared.”

Our trauma team serves kids in three states.After patients are discharged, the trauma team continues to follow them. At the weekly outpatient clinic, general surgeons and nurse practitioners collaborate with physical therapists, occupational therapists and Child Life specialists to help children get back to their normal routines or adjust to life post accident. ACS requires continual tracking and process improvement. Data is collected on each patient, trends are analyzed and care is adjusted across the board.

The trauma team isn’t just analyzing the data on its patients. It’s collaborating with six free-standing children’s hospitals to ask questions about pediatric trauma on a large scale. ATOMAC – a collaboration of hospitals in Little Rock, Oklahoma City, Austin, Dallas, Phoenix and Memphis – is combining research efforts.

“Among the six of us, we see a large volume of patients which allows us to quickly find answers to questions about things that were really difficult to answer or were really rare,” Eubanks said.

The team published in the Journal of Trauma and Acute Care Surgery regarding the need for more aggressive screening on blunt trauma in children. Other studies underway include management of blunt spleen and liver injuries and long-term outcomes for brain injury patients.

Injury prevention efforts follow trauma trends

In response to the trends of emergency room visits and trauma cases, Le Bonheur’s Injury Prevention and Safe Kids Mid-South team has designed programs to meet community needs. Spikes in teenage drowning led to a free swim lesson program based at community center and YMCA pools. High infant mortality rates were, in part, tied to babies sleeping on couches and not riding in car seats. Baby safety initiatives ensure that new moms in the highest risk areas have cribs and new car seats. In 26 years, these efforts, led by a former pediatric intensive care nurse, have led to a decrease in severe child injury rates by 33 percent regionally.