Structure and function of a trauma intensive care unit: A report from the Trauma Intensive Care Unit Prevalence Project

TRIPP Study Group

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND Specialized trauma intensive care unit (TICU) care impacts patient outcomes. Few studies describe where and how TICU care is delivered. We performed an assessment of TICU structure and function at a sample of US trauma center TICUs. METHODS This was a multicenter study in which participants supplied information about their trauma centers, staff, clinical protocols, processes of care, and study TICU (the ICU admitting the majority of trauma patients). RESULTS Forty-five Level I trauma centers trauma centers enrolled through the American Association for the Surgery of Trauma multi-institutional trials platform; 71.1% had less than 750 beds and 55.5% treated 1,000 to 2,999 trauma activations/year. The median number of hospital ICU beds was 109 [66-185]. 46.7% were "closed" ICUs, 20% were "open," and 82.2% had mandatory intensivist consultation. 42.2% ICUs were classified as trauma (≥80% of patients were trauma), 46.7% surgical/trauma, and 11.1% medical-surgical. Trauma ICUs had a median 10 [7-12] intensivists. Intensivists were present 24 hours/day in 80% of TICUs. Centers reported a median of 8 (interquartile range [IQR], 6-10) full-time trauma surgeons, whose ICU duties comprised 25% (IQR, 20%-40%) of their clinical time and 20% (IQR, 20-33) of total work time. A median 16 (IQR, 12-23) ICU beds in use were staffed by 10 (IQR, 7-14) nurses. There was considerable variation in the number and type of protocols used and in diagnostic methods for ventilator-associated pneumonia. Daily patient care checklists were used by 80% of ICUs. While inclusion of families on rounds was performed in 91.1% of ICUs, patient- and family-centered support programs were less common. CONCLUSION A study of structure and function of TICUs at a sample of Level I trauma centers revealed that presence of nontrauma patients was common, critical care is a significant component of trauma surgeons' professional practice, and significant variation exists in care delivery models and protocol use. Opportunities may exist to improve care through sharing of best practices.

Original languageEnglish (US)
Pages (from-to)783-790
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Intensive Care Units
Wounds and Injuries
Trauma Centers
Patient Care
Ventilator-Associated Pneumonia
Professional Practice
Critical Care
Clinical Protocols
Checklist
Practice Guidelines
Multicenter Studies
Referral and Consultation
Nurses

Keywords

  • critical care
  • critical care protocols
  • ICU staffing
  • ICU structure and function
  • Trauma intensive care unit

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Structure and function of a trauma intensive care unit : A report from the Trauma Intensive Care Unit Prevalence Project. / TRIPP Study Group.

In: Journal of Trauma and Acute Care Surgery, Vol. 86, No. 5, 01.05.2019, p. 783-790.

Research output: Contribution to journalArticle

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title = "Structure and function of a trauma intensive care unit: A report from the Trauma Intensive Care Unit Prevalence Project",
abstract = "BACKGROUND Specialized trauma intensive care unit (TICU) care impacts patient outcomes. Few studies describe where and how TICU care is delivered. We performed an assessment of TICU structure and function at a sample of US trauma center TICUs. METHODS This was a multicenter study in which participants supplied information about their trauma centers, staff, clinical protocols, processes of care, and study TICU (the ICU admitting the majority of trauma patients). RESULTS Forty-five Level I trauma centers trauma centers enrolled through the American Association for the Surgery of Trauma multi-institutional trials platform; 71.1{\%} had less than 750 beds and 55.5{\%} treated 1,000 to 2,999 trauma activations/year. The median number of hospital ICU beds was 109 [66-185]. 46.7{\%} were {"}closed{"} ICUs, 20{\%} were {"}open,{"} and 82.2{\%} had mandatory intensivist consultation. 42.2{\%} ICUs were classified as trauma (≥80{\%} of patients were trauma), 46.7{\%} surgical/trauma, and 11.1{\%} medical-surgical. Trauma ICUs had a median 10 [7-12] intensivists. Intensivists were present 24 hours/day in 80{\%} of TICUs. Centers reported a median of 8 (interquartile range [IQR], 6-10) full-time trauma surgeons, whose ICU duties comprised 25{\%} (IQR, 20{\%}-40{\%}) of their clinical time and 20{\%} (IQR, 20-33) of total work time. A median 16 (IQR, 12-23) ICU beds in use were staffed by 10 (IQR, 7-14) nurses. There was considerable variation in the number and type of protocols used and in diagnostic methods for ventilator-associated pneumonia. Daily patient care checklists were used by 80{\%} of ICUs. While inclusion of families on rounds was performed in 91.1{\%} of ICUs, patient- and family-centered support programs were less common. CONCLUSION A study of structure and function of TICUs at a sample of Level I trauma centers revealed that presence of nontrauma patients was common, critical care is a significant component of trauma surgeons' professional practice, and significant variation exists in care delivery models and protocol use. Opportunities may exist to improve care through sharing of best practices.",
keywords = "critical care, critical care protocols, ICU staffing, ICU structure and function, Trauma intensive care unit",
author = "{TRIPP Study Group} and Michetti, {Christopher P.} and Fakhry, {Samir M.} and Karen Brasel and Martin, {Niels D.} and Teicher, {Erik J.} and Chang Liu and Anna Newcomb and Amy Stewart and Grace Chang and Michael Foreman and Rainey, {Evan Elizabeth} and {Dell Moore}, {Forrest O.} and Jessica Huang and Krista Kaups and Dirks, {Rachel C.} and Sensenig, {Rachel L.} and {San Roman}, {Janika L.} and Burlew, {Clay Cothren} and Campion, {Eric M.} and Len Weireter and Katherine Kelley and Dennis Kim and Erin Howell and Charles Hu and Karen Lewandowski and Dauer, {Elizabeth D.} and Kaushik Mukherjee and Penaloza, {Liz G.} and Cullinane, {Daniel C.} and Carrick, {Matthew M.} and Vaidehi Agrawal and Manuel Lorenzo and Dana Ferrari-Light and Michael Coomaraswamy and West, {Michaela A.} and Joseph Farhat and Brasel, {Karen J.} and Ballou, {Jessica H.} and Drumheller, {Byron C.} and Jason Radowsky and Dries, {David J.} and Elizabeth Ramey and Nicole Goulet and Livingston, {David H.} and Meizoso, {Jonathan P.} and Zakrison, {Tanya L.} and Wahl, {Wendy L.} and Brandt, {Mary Margaret} and Nasrallah, {Fady S.} and Schaffer, {Kathryn B.}",
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TY - JOUR

T1 - Structure and function of a trauma intensive care unit

T2 - A report from the Trauma Intensive Care Unit Prevalence Project

AU - TRIPP Study Group

AU - Michetti, Christopher P.

AU - Fakhry, Samir M.

AU - Brasel, Karen

AU - Martin, Niels D.

AU - Teicher, Erik J.

AU - Liu, Chang

AU - Newcomb, Anna

AU - Stewart, Amy

AU - Chang, Grace

AU - Foreman, Michael

AU - Rainey, Evan Elizabeth

AU - Dell Moore, Forrest O.

AU - Huang, Jessica

AU - Kaups, Krista

AU - Dirks, Rachel C.

AU - Sensenig, Rachel L.

AU - San Roman, Janika L.

AU - Burlew, Clay Cothren

AU - Campion, Eric M.

AU - Weireter, Len

AU - Kelley, Katherine

AU - Kim, Dennis

AU - Howell, Erin

AU - Hu, Charles

AU - Lewandowski, Karen

AU - Dauer, Elizabeth D.

AU - Mukherjee, Kaushik

AU - Penaloza, Liz G.

AU - Cullinane, Daniel C.

AU - Carrick, Matthew M.

AU - Agrawal, Vaidehi

AU - Lorenzo, Manuel

AU - Ferrari-Light, Dana

AU - Coomaraswamy, Michael

AU - West, Michaela A.

AU - Farhat, Joseph

AU - Brasel, Karen J.

AU - Ballou, Jessica H.

AU - Drumheller, Byron C.

AU - Radowsky, Jason

AU - Dries, David J.

AU - Ramey, Elizabeth

AU - Goulet, Nicole

AU - Livingston, David H.

AU - Meizoso, Jonathan P.

AU - Zakrison, Tanya L.

AU - Wahl, Wendy L.

AU - Brandt, Mary Margaret

AU - Nasrallah, Fady S.

AU - Schaffer, Kathryn B.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - BACKGROUND Specialized trauma intensive care unit (TICU) care impacts patient outcomes. Few studies describe where and how TICU care is delivered. We performed an assessment of TICU structure and function at a sample of US trauma center TICUs. METHODS This was a multicenter study in which participants supplied information about their trauma centers, staff, clinical protocols, processes of care, and study TICU (the ICU admitting the majority of trauma patients). RESULTS Forty-five Level I trauma centers trauma centers enrolled through the American Association for the Surgery of Trauma multi-institutional trials platform; 71.1% had less than 750 beds and 55.5% treated 1,000 to 2,999 trauma activations/year. The median number of hospital ICU beds was 109 [66-185]. 46.7% were "closed" ICUs, 20% were "open," and 82.2% had mandatory intensivist consultation. 42.2% ICUs were classified as trauma (≥80% of patients were trauma), 46.7% surgical/trauma, and 11.1% medical-surgical. Trauma ICUs had a median 10 [7-12] intensivists. Intensivists were present 24 hours/day in 80% of TICUs. Centers reported a median of 8 (interquartile range [IQR], 6-10) full-time trauma surgeons, whose ICU duties comprised 25% (IQR, 20%-40%) of their clinical time and 20% (IQR, 20-33) of total work time. A median 16 (IQR, 12-23) ICU beds in use were staffed by 10 (IQR, 7-14) nurses. There was considerable variation in the number and type of protocols used and in diagnostic methods for ventilator-associated pneumonia. Daily patient care checklists were used by 80% of ICUs. While inclusion of families on rounds was performed in 91.1% of ICUs, patient- and family-centered support programs were less common. CONCLUSION A study of structure and function of TICUs at a sample of Level I trauma centers revealed that presence of nontrauma patients was common, critical care is a significant component of trauma surgeons' professional practice, and significant variation exists in care delivery models and protocol use. Opportunities may exist to improve care through sharing of best practices.

AB - BACKGROUND Specialized trauma intensive care unit (TICU) care impacts patient outcomes. Few studies describe where and how TICU care is delivered. We performed an assessment of TICU structure and function at a sample of US trauma center TICUs. METHODS This was a multicenter study in which participants supplied information about their trauma centers, staff, clinical protocols, processes of care, and study TICU (the ICU admitting the majority of trauma patients). RESULTS Forty-five Level I trauma centers trauma centers enrolled through the American Association for the Surgery of Trauma multi-institutional trials platform; 71.1% had less than 750 beds and 55.5% treated 1,000 to 2,999 trauma activations/year. The median number of hospital ICU beds was 109 [66-185]. 46.7% were "closed" ICUs, 20% were "open," and 82.2% had mandatory intensivist consultation. 42.2% ICUs were classified as trauma (≥80% of patients were trauma), 46.7% surgical/trauma, and 11.1% medical-surgical. Trauma ICUs had a median 10 [7-12] intensivists. Intensivists were present 24 hours/day in 80% of TICUs. Centers reported a median of 8 (interquartile range [IQR], 6-10) full-time trauma surgeons, whose ICU duties comprised 25% (IQR, 20%-40%) of their clinical time and 20% (IQR, 20-33) of total work time. A median 16 (IQR, 12-23) ICU beds in use were staffed by 10 (IQR, 7-14) nurses. There was considerable variation in the number and type of protocols used and in diagnostic methods for ventilator-associated pneumonia. Daily patient care checklists were used by 80% of ICUs. While inclusion of families on rounds was performed in 91.1% of ICUs, patient- and family-centered support programs were less common. CONCLUSION A study of structure and function of TICUs at a sample of Level I trauma centers revealed that presence of nontrauma patients was common, critical care is a significant component of trauma surgeons' professional practice, and significant variation exists in care delivery models and protocol use. Opportunities may exist to improve care through sharing of best practices.

KW - critical care

KW - critical care protocols

KW - ICU staffing

KW - ICU structure and function

KW - Trauma intensive care unit

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