Take the Trauma Out of Trauma

Project Topic:

Optimizing the care of trauma patients using evidence-based practice and interprofessional collaboration

Hospital, City and State:

Providence Holy Family Hospital, Spokane, WA

Unit:

Emergency Department

CSI Participants:

• Betty Bowman, MSN, RN, CEN, PCN
• Maybelle Smith, BSN, RN, CEN, EMT/P
• Micah Vinning, BSN, RN

Project Goals/Objectives:

1. Improve AACN Healthy Work Environment Assessment Tool (HWEAT) True Collaboration score from 2.98 to 3.0
2. Improve the average nurse's self-reporting of comfort with trauma care 10% in the final survey
3. Decrease the average cost of Emergency Department length of stay 5%
4. Reduce the fiscal impact of lost trauma charges 25%

Project Outcomes:

1. Improved HWEAT True Collaboration score from 2.98 to 4.06
2. Increased the average nurse’s self-reporting of comfort with trauma care 10% in the final survey
3. Increased the average cost of the Emergency Department length of stay by 2.23%
4. No reduction in the fiscal impact of lost trauma charges
5. Improved HWEAT aggregate and all standard scores
6. Potential annualized fiscal impact is $284,224

Project Overview:

The Trauma process improvement initiative at Providence Holy Family Hospital aimed to optimize trauma patient care by improving workflows, enhancing team performance, and reducing the length of stay in the Level 3 Trauma Center Emergency Department (ED). Serving a diverse patient population with 34,980 annual visits, the ED team sought to streamline trauma resuscitation processes and ensure rapid diagnosis and treatment while maintaining a healthy work environment.

The project began with a needs assessment, best practice review, resource evaluation and allocation, and stakeholder engagement. This effort culminated in implementing a designated Trauma Resuscitation Room and enhanced trauma workflows. The project grew from a pivotal moment when a level 1 trauma patient arrived by ambulance that had been under-triaged with catastrophic, unidentified injuries. While the patient's outcome would not have changed, the staff's realization of the inadequate access to resuscitation equipment, needed supplies, and staff training was insufficient for such care.

Key activities included staff education, trauma simulations, leadership engagement, and performance monitoring. A pre-project trauma staff survey was conducted to gather baseline data on staff perceptions, engagement, and workflow challenges, followed by a post-clinical study to assess improvements. Results demonstrated enhanced staff engagement and collaboration, with measurable improvements across all Healthy Work Environment Assessment Tool (HWEAT) scores. While the overall Emergency Department (ED) length of stay (LOS) increased by 2.23%, the data provided valuable insights into the factors influencing patient flow. A closer analysis revealed notable reductions in LOS within the three key areas where ED nurses have the most significant impact—patients discharged to home, transferred to the ICU, or taken to the operating room. These targeted improvements in trauma response efficiency resulted in total annual savings exceeding $284,000, reinforcing the initiative's effectiveness in optimizing patient care and resource utilization.

As part of this initiative, badges were created for staff that listed Level 1 and Level 2 trauma patient criteria, assisting in early identification and initiation of arrival documentation for trauma patients. These badges were well received as a valuable resource and adopted by the city’s sister hospital emergency room, further expanding their impact. Sustainability efforts are centered on ongoing training, strong leadership commitment, and data-driven performance monitoring to ensure continuous improvement in trauma care. The team aims to leverage the Unit-Based Council as a driving force to sustain momentum, foster frontline engagement, and support ongoing initiatives. Additionally, efforts will focus on developing a structured plan to identify and address missed trauma reimbursement, giving an additional opportunity to recover tens of thousands of dollars a month in missed revenue. The initiative will promote staff autonomy, accountability, and continuous quality improvement in emergency care delivery through regular trauma simulations, skill refreshers, and integration of key performance indicators (KPIs).