Role of Serial Phlebotomy in the Management of Blunt Solid Organ Injury in Adults.

BACKGROUND: The management of blunt spleen and liver trauma has become increasingly nonoperative. There is no consensus on timing or duration of serial hemoglobin and hematocrit monitoring in this patient population. OBJECTIVE: This study examined the clinical utility of serial hemoglobin and hematocrit monitoring. We hypothesized that most interventions occur early in the hospital course, based on hemodynamic instability or physical examination findings rather than serial monitoring. METHODS: We conducted a retrospective cohort study of adult trauma patients with blunt spleen or liver injury from November 2014 through June 2019 at our Level II trauma center. Interventions were classified as no intervention, surgical intervention, angioembolization, or packed red blood cell transfusion. Demographics, length of stay, total blood draws, laboratory values, and clinical triggers preceding intervention were reviewed. RESULTS: A total of 143 patients were studied, of whom 73 (51%) received no intervention, 47 (33%) received an intervention within 4 hr of presentation, and 23 (16%) had interventions beyond 4 hr. Of these 23 patients, 13 received an intervention based on phlebotomy results alone. Most of these patients (n = 12, 92%) received blood transfusion without further intervention. Only one patient underwent operative intervention based on serial hemoglobin results on hospital day 2. CONCLUSION: The majority of patients with these injury patterns either require no intervention or declare themselves promptly after arrival. Serial phlebotomy after initial triage and intervention may add little value in the management of blunt solid organ injury.

Reducing Inpatient Falls Through Simulations With Symptom Burden Devices.

BACKGROUND: In-hospital patient falls are a persistent problem in health care, resulting in increased length of stay and nonreimbursable charges. LOCAL PROBLEM: Although fall prevention programs have decreased inpatient fall rates, our hospital averages 30 falls per month. METHODS: This was a quality improvement project, including a simulation and debriefing. We performed a thematic analysis on the debriefing responses and tracked the inpatient fall rates over 8 months. INTERVENTIONS: We developed and implemented a low-cost simulation to allow bedside clinicians to experience the physiological changes experienced by patients, which contribute to inpatient falls. RESULTS: Fifty-one clinicians participated in the simulation; each expressed an increased understanding in the physical limitations of patients and shared at least 1 technique to help prevent falls for their patient population. The fall rate was reduced by 23.17% in the succeeding 8 months. CONCLUSIONS: Clinicians' awareness of patients' physiological changes can be increased by a low-cost, rapid simulation, resulting in fewer falls.

Feasibility assessment for use of Rh-positive blood products during emergency resuscitation in the North Texas trauma population.

The purpose of this study was to evaluate the extent to which a blood bank policy aimed at decreasing the risk of hemolytic disease of the fetus and newborn (HDFN) by limiting emergency-release blood to Rh-negative blood products is effective. We conducted a retrospective review of the trauma registry for all trauma patients evaluated at our level II trauma center. Patients who received blood products within 4 h of arrival were included. Focused chart review was performed to describe the ABO type, Rh blood type, and sex of the blood recipient in the study population. We identified 262 patients who received emergent transfusion, including 64 women. Four of the 64 women (6%) were Rh negative. Of these, one was of childbearing potential, which represents 0.4% of the 262 patients who received emergency-release blood products and 1.6% of the 64 women emergently transfused following trauma. During our study interval, 1527 units of blood were transfused to patients who could have received Rh-positive blood without concern for HDFN. The proscription against Rh-positive blood as an emergency-release blood product only minimally reduces the risk of development of future HDFN in our trauma population.