Performance Improvement (PI) Monitoring

Population Of Interest

- Patients with AIS chest, abdomen, pelvis, and/or lower limb ≥3 with SBP >0 and <90 or CPR in progress on arrival to first MTF AND not isolated head injury (AIS head/face/neck = 5 or 6).
- Patients who received REBOA.

INTENT (EXPECTED OUTCOMES)

1. REBOA is not performed in patients with no signs of life or CPR >15 minutes or isolated severe TBI, penetrating neck injury, or penetrating extremity injury.
2. If performed, REBOA was performed for the indication of hemorrhagic shock associated with abdominal, pelvic, or junctional lower extremity bleeding, or other indication is clearly documented.
3. If REBOA performed, the patient was assessed for thoracic hemorrhage (EFAST or CXR results documented or bilateral chest tubes placed).
4. Blood pressure pre and post REBOA and balloon times (inflation and deflation) are documented in REBOA procedure note.
5. Lower extremity pulses are documented after balloon deflation.

PERFORMANCE/ADHERENCE METRICS

1. Number and percentage of patients who had REBOA performed for hemorrhagic shock associated with abdominal, pelvic, or junctional lower extremity bleeding.
2. Number and percentage of patients who had REBOA performed who were assessed for thoracic hemorrhage (EFAST or CXR results documented or bilateral chest tubes placed).
3. Number and percentage of patients who had REBOA performed with complete REBOA procedure note to include documented blood pressure pre and post REBOA and documented balloon times (inflation and deflation).
4. Number and percentage of patients who had REBOA performed with lower extremity pulses documented after balloon deflation.
5. Number and percentage of patients who had REBOA performed with surgical hemorrhage control procedure or documentation that procedure not needed.
6. Number and percentage of patients who underwent ERT or REBOA in the population of interest.
7. Number and percentage of patients who did not undergo ERT or REBOA in the population of interest.
8. Number and percentage of patients who underwent ERT or REBOA who survived 24 hrs, 7 days, 30 days (assume alive if discharged alive prior to each time point).
9. Number and percentage of patients who did not undergo ERT or REBOA in the population of interest who were declared KIA/DOA or who survived 24 hrs, 7 days, 30 days (assume alive if discharged alive prior to each time point).

DATA SOURCE

- Patient Record
- Department of Defense Trauma Registry (DoDTR)

PI DATA CAPTURE AND REPORTING

- Number of REBOA interventions, performance, and adherence measures will be reported quarterly by JTS PI Branch Chief to the JTS Chief.
- JTS will identify REBOA patients in the trauma registry and facilitate capture of complete medical records.

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 Branch.

RESPONSIBILITIES

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