PERFORMANCE IMPROVEMENT (PI) MONITORING

POPULATION OF INTEREST

All combat casualties with bilateral lower extremity amputations, at least one above the knee, with MOI explosive/IED or landmine, dismounted.

INTENT (EXPECTED OUTCOMES)

1. The pelvis is stabilized prehospital or immediately on arrival to the hospital with pelvic binder or junctional tourniquet placement in all patients with bilateral lower extremity amputations.
2. All patients resuscitated by massive transfusion protocol MTP utilizing LTOWB or balanced resuscitation strategy.
3. All patients who undergo laparotomy have temporary abdominal closure at first operation (or reason to safely close abdomen is documented).
4. All patients with high bilateral lower extremity injuries have a documented digital rectal exam and have a documented proctoscopy if perineal/peri-rectal penetrating wounds are present.
5. When GU injury is present, debridement conserves tissue to the greatest extent possible.
6. All patients with dismounted complex blast injury have a second debridement performed within 24 hours of the initial debridement.
7. All patients have VTE prophylaxis started within 24 hours (or documented reason why contraindicated).

PERFORMANCE/ADHERENCE MEASURES

1. Number and percentage of patients in the population of interest who have the pelvis stabilized prehospital or immediately on arrival to the hospital with pelvic binder or junctional tourniquet placement.
2. Number and percentage of patients in the population of interest who undergo REBOA placement upon arrival to the hospital.
3. Number and percentage of patients resuscitated by MTP.
4. Number and percentage of patients in the population of interest who undergo laparotomy and the number who have temporary abdominal closure at first operation (or reason to safely close abdomen documented).
5. Number and percentage of patients in the population of interest who have documented digital rectal exam.
6. Number and percentage of patients in the population of interest who have perineal/peri-rectal penetrating wounds who have a documented proctoscopy.
7. Number and percentage of patients in the population of interest who have injury to external genitalia who have preservation of injured testicle(s) at the initial operation.
8. Number and percentage of patients in the population of interest who have a second debridement performed within 24 hours of the initial debridement.
9. Number and percentage of patients in the population of interest who have VTE prophylaxis started within 24 hours (or documented reason why contraindicated).
10. Number and percentage of patients in the population who survive evacuation from first MTF and the number who survive to final discharge from Role 3/Role 4.

DATA SOURCE

- Patient Record
- DoD 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 JTS Chief and the JTS PI team.

RESPONSIBILITES

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