In a Level IV center, small changes make a big impact

Daniel S. Paley, M.D., knows the challenges of performance improvement (PI) in a Level IV Trauma Center better than most. Dr. Paley is one of three on-call surgeons at Owatonna Hospital in Owatonna, Minn. A series of recent turnovers and transitions put PI on hold there for nearly a year. But Dr. Paley says not only is PI back, it has led to positive and demonstrable changes in patient care.

One is the expedited exchange of information between Owatonna and Saint Marys, one of Mayo Clinic's hospitals in Rochester, Minn., and a Level I Adult and Level I Pediatric Trauma Center.

Dr. Paley explains, "We're working on our transfer protocol, trying to streamline the process so that when patients arrive in Rochester, the receiving team has as much pertinent information as possible. Initially, we started thinking about how to get images there before the patient arrived, and we've been able to coordinate care so that all of our X-rays are now accessible to Rochester and vice versa."

The next step was finding a faster way to transfer data.

"We looked at what information the receiving center wanted and how we could get it processed more quickly," Dr. Paley says. "Now, things are collated during the resuscitation. We have a scribe nurse, so the findings are called out as the resuscitation is being done. Before, findings were dictated, and the receiving facility wouldn't have them."

He adds, "We want to treat the patients we can, but for those we can't, we want to be sure things get transferred expeditiously. We're still figuring out our capabilities, and of course over time, those capabilities will evolve. As the hospital grows — and we are growing in terms of volume — we'll have to keep evaluating."

Dr. Paley says perhaps the biggest and most important change has been to treat patients more like codes than consults.

"When a patient comes in now, we are more likely to have a team present. That wasn't the case a few years ago, he explains. "Even when patients are looking well, treating them like codes means we bring all our resources to bear for a shorter, intense period of time. That's really the biggest thing."

Dr. Paley says the improvements are a testament to providers in the Owatonna Hospital ED, including the trauma director, who actively reviews ED cases, and to the Mayo Clinic trauma team in Rochester, which provided mentoring and support.

He says the regional trauma committee has also been invaluable.

"They helped us organize our priorities and put together evidence-based guidelines that allow us to make use of regional knowledge. We learn what's out there that we might not know about, bring it back to our facility and use that as our starting point. Learning what our colleagues at larger hospitals are doing is really the best place to start."

He adds, "Everyone here is genuinely interested in making things better and trying to do what's right for patients. There have definitely been challenges, but I think we have made some significant progress."