PERFORMANCE IMPROVEMENT MONITORING

POPULATION OF INTEREST

1. All patients with exposure to radiation
2. All patients with exposure to radiation and concomitant trauma injuries (Severe ISS >16 and >2 body regions with AIS >= 2, SBP <100, HR > 100 within 3 hours of injury)
3. All patients with exposure have dosing estimates documented, either from direct dosimetry or clinical criteria.

INTENT

1. Biodosimetry estimated on all patients using exposure time, time to vomiting, +/- ANC.
2. Radionuclides are identified as early as possible, and countermeasures enacted according to Table 10.
3. Complete blood counts are performed as early as possible and repeated every 8 hours for patients with >1Gy exposure.
4. Patients with >1Gy exposure requiring surgery receive surgery as soon as possible.
5. Patients with >2Gy exposure receive countermeasures according to Table 11.
6. Patients with ANC<1000 receive gut decontamination.
7. Patients with >1Gy requiring blood products receive irradiated leukocyte-reduced blood.

PERFORMANCE/ADHERENCE METRICS

- Number and % of patients with exposure who have documented exposure estimates.
- Number and percentage of patients with combined injuries (exposure plus trauma/burn).
- If burn present – document %TBSA
- Document time of exposure and exposure time (duration of exposure)
- Document PPE
- Document source and type of radiation if known
- Document time to emesis
- Document temperature Q1 hour for first 4 hours and then Q2 hours for first 24 hours

DATA SOURCES

- Patient record
- DoD Trauma Registry
- TMDS

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 JTS Chief and the JTS PI team will perform the systems review and data analysis.

RESPONSIBILITIES

The trauma team leader is responsible for ensuring familiarity, appropriate compliance, and performance improvement monitoring at the local level with this CPG.