Trauma is Risky Business
Deborah Stein SMACC Chicago talk Trauma is Risky Business – delves into the risk patients and physicians undergo when treating or being treated for Trauma.
Stein’s speaks of the Risk Benefit Determination that physicians make daily and how this is used to best answer on going questions such as; can a patient have?, how do we care for this patient? and how do we best make all the these decisions?.
Stein’s suggests a thorough Risk Benefit Determination will include:
# Analysis of best available data
# Use of best available judgement
# Gathering of different opinions
# An understanding that you won’t always make the right decision
# To document the ‘crap’ out of it!
# And, to remember you’ll never know what you prevented from not occurring.
Stein’s also focuses on the risk to patients due to missed injuries, stating that 1.3-39% of injuries in trauma are missed (a majority of which present as orthopaedic cases). And, touching on the processes designed to prevent missed injuries such as; Territory Trauma Survey, Roles of Clinical Decision Rules, to scan the living ‘crap’ out of them – whole body CT scans (can decrease mortality but comes attached with its own risks).
Stein’s then delves into the risks trauma providers (physicians) face on a daily bases. Stating that in the USA trauma providers are one of the highest categories of physicians to be sued, have higher indemnity payment awarded against them and achieve a higher risk score in studies for being sued. While, lawsuits are more likely to increase the chance of physician burnout, career burnout, depression and are emotionally and physically exhausting. Steins sights recent studies that suggest the more open, honest and forthright a physician is with their error with their peers and their hospital, the likelihood of being sued reduces.
Stein’s also notes that needle stick injuries in most departments have decreased in recent years due to universal precautions, yet have increased in trauma care due to the nature of the ER environment and proper precautions not being taken. Violence is of risk to attending ER nurses, physicians and paramedics, sighting an Australian study that 79% of triage nurses have experienced physical violence from patients. And, the emotional harm the trauma environment can have on trauma providers.
Steins suggests that trauma providers must be aware and learn how to manage risk better to ensure patient and provider safety.