Performance Improvement (PI) Monitoring

POPULATION OF INTEREST

Patients with pelvic fractures

INTENT (EXPECTED OUTCOMES)

1. Patients in the population of interest with pelvic ring injury and hemodynamic instability (SBP < 100, < 110 in patients with suspected traumatic brain injury, or HR > 100) receive pelvic stabilization with an appropriately placed pelvic binder (sheets or binder).
2. Hemodynamically unstable patients with hemoperitoneum and unstable pelvic ring injury undergo preperitoneal packing and pelvic external fixation or pelvic binder (at minimum) in addition to an exploratory laparotomy.
3. Hemodynamically unstable patients with an unstable pelvic ring injury without hemoperitoneum undergo emergent preperitoneal packing or pelvic angioembolization plus pelvic stabilization (external fixation or binder).

PERFORMANCE/ADHERENCE MEASURES

1. Hemodynamically unstable patients (SBP < 100, or 110 in patients with suspected traumatic brain injury, or HR >100) with a pelvic ring injury, received pelvic stabilization with appropriately placed sheets or binders.
2. Patients with pelvic fracture and a positive FAST who remain hemodynamically unstable after blood resuscitation, undergo hemorrhage control procedure (exploratory laparotomy, preperitoneal packing, external fixation or pelvic binder at minimum) at the same level of care where diagnosed.
3. Patients with unstable pelvic fracture and a negative FAST who remain hemodynamically unstable after pelvic binder placement and blood resuscitation, undergo hemorrhage control procedure (external fixation and preperitoneal packing or interventional radiology angioembolization, if capability available) at the same level of care where diagnosed.

DATA SOURCE

- Patient Record
- Department of Defense Trauma Registry

SYSTEM REPORTING & FREQUENCY

The above constitutes the minimum criteria for PI monitoring of this CPG. System reporting will be performed annually; additional PI monitoring and system reporting may be performed as needed.

The system review and data analysis will be performed by the Joint Trauma System (JTS) Chief and the JTS Performance Improvement Branch.

RESPONSIBILITIES

It is the trauma team leader’s responsibility to ensure familiarity, appropriate compliance and PI monitoring at the local level with this CPG.