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Traumatic Brain Injury (TBI) and Intracranial Pressure Monitoring (ICP) Clinical Presentation versus Data Interpretation
Darlene Sweet, MSN RN CCRN, Justin DiLibero DNP, RN APRN-CNS, Martina Stippler, MD, Bonnie Butt, CSTR CAISS
Beth Israel Deaconess Medical Center
Introduction/Problem
BACKGROUND:
The American College of Surgeons (ACS) monitors guidelines and clinical practice to ensure
that optimal care is provided to the injured patient. During our last Level I Trauma Center
Re-verification we were questioned about our high number of Traumatic Brain Injured (TBI)
patients and our low number of Intracranial Pressure Monitoring (ICP) monitor placement in
these patients. The ACS application required that we use the initial Glasgow Coma Scale
(GCS) < 8 for all patients with TBI. After retrospective review, we determined that this was a
data issue and not a clinical practice issue. Ensuring accurate data is important for reporting
purposes and to the identification of meaningful opportunities for improvement.
Aim/Goal
OBJECTIVE:
To develop a process with the Neurosurgery team to ensure
that our data matches our clinical practice
The Interventions
Ensuring accuracy in our reporting data:
Meetings were scheduled with Neurosurgery and Trauma
2 meetings were held to further discuss the weakness described by the ACS during our
Level I Site Review
Retrospective review of all trauma patients with TBI and a GCS < 8 with and without ICP
monitor placement was done by the trauma and neurosurgery department
Interpretation of data capture and report writing was done by the Trauma Registrar
Identification of data reporting elements versus clinical decision making allowed for a quick
resolution of the problem
Validation of the trauma registry report is completed by neurosurgery and trauma every
month. Clinical decision making is captured in a separate report and maintained by the
trauma department. All data is then cleaned within the trauma registry to ensure accurate
reporting.
The Team
Darlene Sweet, MSN RN Trauma Program Director
Justin DiLibero, DNP, RN APRN-CNS Neurosurgery Team TBI Coordinator
Martina Stippler, MD Neurosurgeon
Bonnie Butt, CSTR, CAISS Trauma Registrar
For more information, contact:
Darlene Sweet, MSN RN, Trauma Program Director, dsweet1@bidmc.harvard.edu
�Traumatic Brain Injury (TBI) and Intracranial Pressure Monitoring (ICP) Clinical Presentation versus Data Interpretation
Darlene Sweet, MSN RN CCRN, Justin DiLibero DNP, RN APRN-CNS, Martina Stippler, MD, Bonnie Butt, CSTR CAISS
Beth Israel Deaconess Medical Center
Results/Progress to Date
• Data Cleanup:
Conclusion
• In some patients with an initial documented GCS of < 8 the actual GCS was found
•
•
•
•
to be > 8 on assessment by the neurosurgery team
Among patients with an actual GCS < 8 some patients experienced an
improvement in GCS to > 8 in the first 24 hours
This data was not captured in the trauma registry
Some patients were made CMO for un-survivable brain injury and/or died within the
first 24 hours removing them from candidacy for ICP placement
Data cleanup and clinical decision making validation was necessary in order to
ensure accuracy in data reporting
Monthly Review:
Trauma Registrar sends out the TBI report
to both Trauma Director and Neurosurgery
Team TBI Coordinator
Next Steps
Ongoing monitoring of all TBI patients and ICP monitoring
placement will occur
This project has allowed us to see and understand our data
reporting more clearly. We are now ensuring that all our data
and data definitions are accurate by reviewing our ACS
reporting data on a monthly basis.
Darlene Sweet, MSN and Justin DiLibero, DNP CNS plan to
speak at a Grand Rounds and hopefully an upcoming
conference to help others with defining data elements and
cleaning the data
Monthly review of all patients is
done by both teams
Outliers are sent to Dr. Stippler
for further review and cases
flagged are presented at the
Trauma Committee M&M
meeting.
Validation is kept in a data base and
maintained by the Trauma Department
Changes in the GCS within the first 24
hours are then documented in the Trauma
Registry and new reports are run to ensure
accuracy in future data reporting
For more information, contact:
Darlene Sweet, MSN RN, Trauma Program Director, dsweet1@bidmc.harvard.edu
�
Dublin Core
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Darlene Sweet (<a href="mailto:dsweet1@bidmc.harvard.edu">dsweet1@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery - Trauma
Neurosurgery
Project Team
Darlene Sweet
Justin DiLibero
Martina Stippler
Bonnie Butt
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Traumatic Brain Injury (TBI) and Intracranial Pressure Monitoring (ICP) Clinical Presentation Versus Data Interpretation
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Safety