As the only regional trauma center in south Orange County, California, St. Joseph Health's Mission Hospital in Mission Viejo must embrace staffing as a complex, collaborative care issue. As a result, they honed a trauma team staffing model by developing an algorithm involving dedicated primary, emergency department (ED) and critical care trauma nurses capable of adjusting to influxes of trauma patients and dedicated to the entire initial phase of trauma care.
Mission Hospital is a 24/7 American College of Surgeons (ACS) Certified Level II Adult and Level II Pediatric trauma center, with more than 530 beds, in partnership with CHOC Children's. Around the clock, the facility ensures that they're ready for high-level traumas with appropriate staff and resources for any situation.
They must also be mindful of the individual departmental needs of their trauma, ED and surgical ICU (SICU) to ensure the optimal staffing for achieving the best possible critical care outcomes.
According to primary trauma nurse Jennifer Schollenberger, the hospital was faced with a rapidly increasing number of trauma patients. They needed an improved process to quickly identify and provide the necessary resources to resuscitate high-acuity patients, yet manage the breadth of the workload.
"We recognized the importance of determining gaps in care practice, patient safety stressors involved with staffing an influx of patients over a short timeframe and an evaluation of the impact on the staffing in both the ED and SICU departments," Schollenberger says.
To address this issue, Mission Hospital blended ED and critical care nurses into the Trauma Team, recognizing that their skills made them ideal care providers for trauma patients during the entire resuscitation phase — from ED and diagnostics to admission, surgery and discharge.
The team consists of primary trauma nurses — all with critical care backgrounds who work full time in the Trauma Department — and ED and SICU trauma nurses who work part time. With the hospital's steady flow of trauma patients, this model also allows for trauma-trained nurses in ED/SICU to assist during mass casualty incidents.
Trauma nurses have learned to provide quality care in a fast, unpredictable environment while triaging and caring for patients. They must quickly recognize acute concerns while resolving or stabilizing life-threatening conditions. The skillset and preparation of these critical care nurses make them the optimal choice in this setting.
Additionally, trauma nurses must work independently, recognize early signs of patient clinical deterioration while acting confidently and quickly to manage emergent patient needs and prevent crises. To Schollenberger and her team, critical care nurses matched these skills.
"A critical care nurse, who cares for the most fragile of patients day in and day out, performs ideally in this role," Schollenberger says. "What better complement to the expert triage and immediate management skills of an ED nurse than a critical care nurse, whose experience lies in managing patients' needs in their sickest moments?"
Mission Hospital blended ED and critical care nurses into the Trauma Team, collaborating with trauma surgeons, medical teams and rapid response staff to provide total trauma patient care.
Measures of Success
As an ACS verified trauma center, Mission Hospital abides by a rigorous Performance Improvement Patient Safety (PIPS) review system. With detailed, real-time case reviews and physician-peer input processes, the PIPS system has earned them a quality rating of "transformational" in their most recent verification survey.
Since implementing the trauma team staffing model five years ago, Mission Hospital's optimal staffing has:
- Improved patient outcomes in the most critical cases.
- Patient mortality rate data below or meeting National Standard benchmark average in all risk-adjusted trauma patient groups — per Trauma Quality Improvement Program (TQIP) National Data Registry.
- Ninety-eight percent of trauma patients with bleeding injuries (identified by CT scan and previously on anticoagulants) were reversed within one hour of CT results.
- Experienced reduction in trauma ED diversion rates to nearly zero percent.
- Maintained optimal outcomes while transitioning through two different physician groups.
- Not lost any department nurses based on discontent.
- Seen all team members strive for advanced degrees, specialty certifications and advanced clinical roles.
- Established an annual trauma conference.
Additionally, the team provides the county's only Advanced Trauma Certified Nurse course open to the community. Meanwhile, they have earned the prestigious ACS Pediatric Trauma Level II verification and noted as a "best practice" during the most recent verification process.