Purpose:
To meet 4.15 from “Resources for
the Optimal Care of the Injured Patient, 2022
Standards” by the American College
of Surgeons Committee on Trauma Verification Review Committee.
CD 4.15 states “Level I and II
trauma centers must have the necessary human and physical resources
continuously available so that an
endovascular or interventional radiology procedure for hemorrhage
control can begin within 60
minutes of request.”
Guideline:
The 60-minute requirement will apply to the following patients requiring interventional radiology (IR):
· All trauma patients who require interventional angiography within the first 24 hours of arrival and have active extravasation from the abdomen, pelvis, chest or proximal extremity AND exhibit one or more of the following:
·
Shock (eg: SBP <90,
tachycardia, persistent lactic acidemia)
·
Require blood products within the
first 4 hours of admission
·
Intraoperative consult for acute
traumatic hemorrhage
STAT IR Process:
·
TS Attending/Fellow/Chief/Junior/Critical
Care APP calls IR APP to convey criteria are met and provides a direct call
back number for communication
o 7A-5P: In house (859 330-1729)
o 5P-7A: IR on call APP (859 330-1729)àV1
on call IR Attending (In lightning bolt, UKMD can connect directly)
·
IR Attending calls TS for
discussion
·
TS conveys to the IR Attending
that criteria are met for STAT Trauma IR intervention
(provides MRN and patient
location)
·
IR Attending/TS discuss findings-Consensus
is achieved
·
TS writes
note documenting consensus and IR team call-in
·
IR Attending to initiate call-in
process for IR staffing
·
TS assigns Resuscitationist (trauma
junior and/or Critical Care APP) who:
o
Activates MTP (calls blood bank 3-5401
and enters order)
o
Notifies the Trauma DCN (562-6811)
o
Starts Epic Urgent group chat
(Trauma DCN, IR Attending, PI Staff, Resuscsitationist)
·
Trauma DCN will assign ICU RN to the
patient
·
Immediate transport to IR room 29/30 (“TAXI AND HOLD”)
·
Anesthesia services may be
utilized in STAT Trauma IR cases at the discretion of the IR or Trauma
Attending. If Anesthesia services are being utilized, the IR Attending or TS
Point Person will call the OR front desk to speak directly with the Anesthesia
Board Runner.
· TS Resuscitationist accompanies patient to the IR suite and all team members assist to transport the patient onto the IR table
·
Quick prep in IR with expedited case start similar to stroke
cases
Additional Notes:
·
Given the stat nature of the
procedure, cases that qualify for STAT Trauma IR consult based on the criteria
above are considered life threatening with implied consent as per KRS
304.40-320
·
Room 9 will be the designated IR suite
·
If Anesthesia will be providing
critical care support in the IR suite the anesthesia cart will be prepped and
available for use at all times in the IR suite, confirmed ready by the
Anesthesia Safari Tech
Times will be documented for the following and tracked through the PIPS process:
·
Time of IR Consult
·
TS note (urgent chat) -Consensus
·
IR team arrival time
·
Time “room ready”
·
Patient arrival time in IR suite
·
Procedure start time
·
Puncture time- Needle
