Performance Improvement (PI) Monitoring

Population of Interest

All trauma patients with blunt trauma injury type and any AIS-abdominal code.

Intent (Expected Outcomes)

1. Hemodynamically unstable (SBP < 90) blunt trauma patients with positive FAST undergo laparotomy (unless documented reason to delay/avoid).
2. All patients with grade IV and V splenic injuries requiring long-range evacuation undergo splenectomy or reason for non-operative management is documented.
3. Selective non-operative management of hemodynamically stable Grade I-III blunt splenic injury is performed at Role 2E, 3 or 4.
4. All patients who undergo splenectomy receive splenectomy vaccinations.

Performance/Adherence Metrics

1. Number and percentage of patients in population of interest with SBP <90 and positive FAST on arrival to a surgical capability who undergo exploratory laparotomy at the same level of care.
2. Number and percentage of patients with grade IV and V splenic injuries who undergo splenectomy.
3. Number and percentage of patients with each grade of splenic injury who are managed non-operatively.
4. Number and percentage of patients who undergo splenectomy who have documentation of pneumococcal and Haemophilus influenza vaccines.

DATA SOURCES

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

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) Director, JTS Program Manager, and the JTS PI Branch.