Clinical Activities

According to the ACS-COT (2014), it is the role of the TPM to, “coordinate management across the continuum of trauma care, which includes the planning and implementation of clinical protocols and practice management guidelines, monitoring care of in-hospital patients, and serving as a resource for clinical practice” (p. 42).

Trauma protocols should be evaluated for content based on the individual facility’s protocol review policy, but should be reviewed and updated within the last five years to assure compliance with national standards and practice updates.  Practice management guidelines go hand-in-hand with protocol development.  The guidelines should be evidence based. The goal of a practice management guideline is to decrease variation in practice by following established standards of care. Practice management guidelines can be clinical (i.e. massive transfusion protocol) or administrative (i.e. trauma on-call response time guidelines).  Appropriate stakeholders should be consulted during the development of a practice management guideline, in order to assure compliance with the most up-to-date standards and to increase buy-in from providers. All practice management guidelines should be monitored for compliance and achievement of desired outcomes.  This can be accomplished through the trauma program’s performance improvement process. 

An important take-away from this section is: DO NOT REINVENT THE WHEEL. Chances are, if the trauma care facility is in need of a practice management guideline other facilities have already developed something similar.  Use available resources to find what others have developed and tailor it to the facility’s needs.  Resources available include, but are not limited to, the following examples:

• Level I or II trauma centers who are the facility’s major referral centers
• The facility may belong to an industry healthcare system, contact the TPM at partnering facilities
• Several Professional Organizations share best practice guidelines on their websites
  • American College of Surgeons
  • American College of Emergency Physicians
  • Brain Trauma Foundation
  • Pediatric Trauma Society
  • Eastern Association for the Surgery of Trauma
  • Western Trauma Association
• Listserv participation can also be helpful to posit questions to
  • Society of Trauma Nurses
  • Iowa Hospital Association – Iowa Trauma Coordinators

Other TPM duties may include monitoring care of in-hospital patients to assure ease of transition from pre-hospital care to discharge, including transfer to definitive care and/or rehabilitation.  The smoother this process is at the facility, the better functioning the trauma program will be and the faster patients will travel through the trauma continuum on their road to recovery.  The TPM may also serve as a resource for clinical practice, including answering practice questions, educating staff, and widely distributing practice guideline updates to assure high-quality evidence based care is being followed by the trauma program.

The TPM should consider participation in the Emergency Room, Trauma Intensive Care Unit, and Trauma Medical-Surgical staff meetings.  Participation in these meetings will provide visibility to the job duties of the TPM, provide a venue for information sharing, and provide a forum for education on trauma care.  Becoming an active member of hospital committees that have a stake in trauma, will allow the TPM to build relationships with subject matter experts which, in turn, will strengthen the program through evidence based practice sharing and buy-in. Active participation in unit based committees will also provide the TPM with a resource for barriers to providing safe, effective care to trauma patients.  It will be the work of the trauma program to help remove those barriers and work towards providing optimal care to the injured patient.