Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma.

OBJECTIVE: Mild traumatic brain injuries (MTBI) associated with intracranial haemorrhage are commonly transferred to tertiary care centres. Recent studies have shown that transfers for low-severity traumatic brain injuries may be unnecessary. Trauma systems can be overwhelmed by low acuity patients justifying standardisation of MTBI transfers. We sought to evaluate the impact of telemedicine services on mitigating unnecessary transfers for those presenting with low-severity blunt head trauma after sustaining a ground level fall (GLF). METHOD: A process improvement plan was developed by a task force of transfer centre (TC) administrators, emergency department physicians (EDP), trauma surgeons and neurosurgeons (NS) to facilitate the requesting EDP and the NS on-call to converse directly to mitigate unnecessary transfers. Consecutive retrospective chart review was performed on neurosurgical transfer requests between 1 January 2021 and 31 January 2022. A comparison of transfers preintervention and postintervention (1 January 2021 to 12 September 2021)/(13 September 2021 to 31 January 2022) was performed. RESULTS: The TC received 1091 neurological-based transfer requests during the study period (preintervention group: 406 neurosurgical requests; postintervention group: 353 neurosurgical requests). After consultation with the NS on-call, the number of MTBI patients remaining at their respective ED's with no neurological degradation more than doubled from 15 in the preintervention group to 37 in the postintervention group. CONCLUSION: TC-mediated telemedicine conversations between the NS and the referring EDP can prevent unnecessary transfers for stable MTBI patients sustaining a GLF if needed. Outlying EDPs should be educated on this process to increase efficacy.

Why Has the BMI gone up so drastically in the last 35 years?

OBJECTIVES: We attempted to answer the following questions: Why has the body mass index (BMI) increased so dramatically in the last 35 years? Are some food groups or additives more responsible than others? METHODS: Data for per capita food production available for consumption after spoilage for different food groups and additives from the US Department of Agriculture were used as independent variables to predict BMI increases. The heights and weights were taken from the Centers for Disease Control and the US Census Bureau for the years 1970 to 2004. RESULTS: The additives of fats and sugars in combination, not separately, best predicted increases in BMI accounting for 97% of the variance in the linear regression analyses. When all food groups were entered into regressions to predict increases in BMI, fats and sugars in combination accounted for 96% of the variance for women and 97% for men, with the other food groups adding very little. Path analyses showed that fat and sweeteners had direct effects on BMI and were also the mediators of increased caloric consumption. CONCLUSIONS: In line with the major physiological theories emphasizing palatability as the addictive stimulus in models of incentives and addiction, fats and sugars in combination rather than calories per se or particular food groups accounted for the increases in BMI. These empirically based theories and data suggest that one should focus on palatability and addictive models in dealing with the increasing problem of obesity in the United States.