1. July 11th 2018

2. CTN Agenda

3. 2017 Elected Officers President: Mike Archuleta, Centura Trauma System
Vice President: Valerie Brockman, Castle Rock Adventist Hospital
Treasurer: Robbie Dumond, University of Colorado Hospital
Secretary: Wendy Hyatt, Swedish Medical Center

4. 2018 CTN Goals Direction Meetings Education Registry Injury Prevention

5. Treasurer Report

6. CTN 2018 Q2 Financials Dues Collected (01/2018-Current) $5018.50
Current Balance- $26,425.29
Awaiting invoice from STN for Optimal Course at RMTC
CTN 2018 Q2 Financials

7. CTN 2018 Annual Budget Income: Expenses: Dues $2,500.00
Income:
Dues $2,500.00
TOTAL INCOME $2,500.00
Expenses:
Mailings/ Postage $
Safety Deposit Box $
CTN Meeting Food $500.00
Spring Conference $600.00
Winter Conference $600.00
Other Course Fees and Expenses $700.00
TOTAL EXPENSES $2,500.00
NET- $0
*Funds Available as of January 5, $24,519.86

8. CTN Dues Structure-2018 Individual- Facility- Per person- $60
2 people- $100
3 people- $160
4 people- $200
5 people or greater- $285
Make checks payable to :
COLORADO TRAUMA NETWORK, INC.
Send payments to:
Robbie Dumond, CTN Treasurer
11691 Pine Hill St.
Parker, CO 80138

9. Dues Received Centura- Parker Adventist SCL Lutheran
Facility
Keefe Memorial- Cheyenne Wells
Montrose Memorial
Colorado Plains- Fort Morgan
St. Mary's- Grand Junction
Longs Peak Hospital- UC Health
Denver Health
Valley View- Glenwood
Univ. of Colorado Hospital- UC Health
HealthONE Medical Center of Aurora
Banner- North Colorado Med. Ctr.
Memorial Hospital North- UC Health
Facility
Centura- Parker Adventist
SCL Lutheran
Centura- (PENROSE)
Medical Center of the Rockies- UC Health
Vail Health
Memorial Hospital- UC Health
Kit Carson County Hospital
Banner- McKee Medical Center
Centura- St. Francis
SCL Good Sam
Children’s Hospital
East Morgan County Hospital
Facility
Centura Castle Rock
Melissa Memorial Hospital
Centura- Littleton Adventist
Centura- St. Anthony's North
Middle Park- Grandby/ Kremmling
Parkview
Centura - Porter
Centura- St. Anthony's
Swedish Medical Center

10. Fillable Invoice Invoice to be sent via email
Also available on the CTN Website
Complete areas in red and submit with payment

11. CTN Education Committee
Nancy Bartkowiak, chair
Sherrie Peckham
Robbie Dumond
Wendy Hyatt
Mike Archuleta
Valerie Brockman

12. Fall Conference December 14, 2018-Rita Bass Conference Center Agenda
Focus on registry and PI
Martin to speak about the new registry
P/P group to IRR (data validation on the top fields that can be tricky
Case Studies
Poster Presentations
Seeking posters that you have submitted and were accepted at conferences for presentation at the meeting
Booths
Invite all trauma registry vendors
No white elephant exchange

13. Spring Conference 2019 May 3, 2019- Swedish Medical Center
Lessons learned:
Shorter day
30 min lunch
Breakout groups available via phone
Key topic:
Psych First Aid for you and your trauma teams
Potential other topics:
Government affairs- CO legislation
Trauma criteria
How to innovate your trauma program
Breakout groups according to job description instead of level of trauma center?

14. CTN TPM/TNC PI/Registry Subcommittee

15. TPM/TNC PI committee
Chair :Stephanie Vega UC Health
Wendy Erickson St. Francis
Robbie Dumond UC Health
Valerie Brockman Castle Rock
Sherry Peckham Denver Health
Missy Sorensen Swedish
Christine Thorkildsen-MCR
Adriana Heins-PVH
Valorie Peaslee-Long’s Peak 

16. UCHealth Medical Center of the Rockies Level II PI

17. Registry Staff Run Daily Reports to identify Trauma Patients and Place in our Excel Log Book
Trauma Nurse Clinicians also identify patients from the daily patient list and enter into the Excel Log Book
(Patient name and MRN number are in the first two boxes)
Daily Work Flow

18. Classification/Stratification
The Registrars are doing concurrent abstracting
Critique reports are run to identify critiques including clinical practice guidelines and complications to be reviewed
Trauma Nurse Clinicians then review at Level 1
Example of Acute Kidney Injury Complication Gg
If not able to close it moves to Level II review with TPM and TMD
Complication
1 or 2 Review
NTDB Definition
Classification/Stratification
Review Questions
Acute Kidney Injury 2
Acute Kidney Injury, AKI (stage 3), is an abrupt decrease in kidney function that occurred during the patient’s initial stay at your hospital. KDIGO (Stage 3) Table: (SCr) 3 times baseline OR Increase in SCr to ≥ 4.0 mg/dl (≥ μmol/l) OR Initiation of renal replacement therapy OR, In patients < 18 years, decrease in eGFR to <35 ml/min per 1.73 m² OR Urine output <0.3 ml/kg/h for > 24 hours OR Anuria for > 12 hours A diagnosis of AKI must be documented in the patient’s medical record. If the patient or family refuses treatment (e.g., dialysis,) the condition is still considered to be present if a combination of oliguria and creatinine are present. EXCLUDE patients with renal failure that were requiring chronic renal replacement therapy such as periodic peritoneal dialysis, hemodialysis, hemofiltration, or hemodiafiltration prior to injury.
Minimal: Any NTDS criteria of AKI without need for RRT Moderate: Need for RRT (CVVH, CVAH, HD) Severe: Need for RRT (CVVH, CVAH, HD) in a patient >65 years of age or patient with baseline creatine >1.5 (or a baseline GFR <50 ml/min/1.73 m2) or need for mechanical ventilation at time of start of dialysis
Did pt. require dialysis? What was baseline creatinine(before injury or admit)?
Were fluids initiated within __12_ hrs? if urine output less than 0.5 cc/kg/hr
Was nephrology consulted? What was highest creatinine measurement-before dialysis?
Did AKI resolve before DC? Risk factors:contrast,CRI,shock,drugs(Vanc/zosyn)
Trauma Base Entry

19. Level 1 Merge Document for Level II Review

20. Level 1 Document Continued

21. Level 1 Document Continued
The discussion from each case is typed into Trauma Base at the Level II meeting in the PI Screens

22. A Level II merge document is then created
Cases are assigned to providers and or staff
These two documents are ed to them securely
These are reference documents for Tertiary Review Meeting

23. Peer Review Committee-Cases Reviewed Tertiary Review Meeting Agenda
Introductions
Old Business
Subcommittee Reports
TOPIC
Injury Prevention
Trauma Reports
Admission Volume
Admission with ISS > 15
Full Teams from the Field
Under/Over Triage
Trauma Activations
Transfer In
Direct Admissions
Teams Not Admitted To Trauma
Non Surgical Admits
Attendance
Education
Case Reviews
New Business
Announcements ⃰ Minutes are then prepared and shared with our Quality Department

24. PI at a Level IV

25. Document date of when secondary review occurs, and what was discussed
Case summary and a timeline of events for patient’s hospital course
Notes from discussion of case at peer review
Summary as to why this was reviewed and what issues were noted by trauma coordinator, and whether this problem requires further review.
All the ‘to-do’s’ and action items recognized during each step of the review process
Summary of how each action item was addressed and the outcomes

26. Quick summary Document, document, document!
Every conversation that is had regarding the case is documented. If the conversation was had in person, I inform that person that I am going to send them an with a summary of what we spoke about. I then send the , and save it in a folder with all the other information and communication about the specific patient visit. If there isn’t evidence the conversation was had, you can’t fall back on it.
In the loop closure, I reference the date of the to check that is was completed.
Quick summary

27. Injury Prevention Subcommittee

28. Injury Prevention subcommitee
Chair:Darcy Martin Swedish Medical Center
Christina Norman Denver Health
Alison Weston UC Health
Angela Kedroutek Centura Penrose
Lauren Stenger Good Samaritan
Laurie Lovedale UC Health
Lori Morgan UC Health
Marilyn Johnson North Colorado Medical Center
Mike Archuleta Centura St. Mary Corwin
Robert Hayes St. Anthony
Robyn Wolverton UC Health
Injury Prevention subcommitee

29. Who Responded:
St. Mary’s Medical Center (Grand Junction)
Telluride Regional
Denver Health
UC Health (North Region) Ft. Collins
Swedish Medical Center
St. Anthony Hospital
Medical Center of Aurora
Colorado Plains Medical Center (Fort Morgan)
Colorado Canyons Hospital (Fruita)
AAH, SANHC, 84th NHC (Louisville) Centura
San Luis Valley Regional (Alamosa)
Gunnison Valley
Pagosa Springs Medical Center
Banner North (Greeley)
Children’s Hospital Colorado
Montrose Memorial
Porter Adventist
Kit Carson County Memorial (Burlington)
Lincoln Community (Hugo)
Centennial Medical Plaza
St. Anthony Summit (Frisco)
Mercy Regional Medical Center (Durango)
Lutheran Medical Center
Littleton Adventist
North Suburban
Parker Adventist
70 surveys sent to Level l, ll and lll Trauma Centers 28 responses received

30. Results Response to questions (28 responses) 89% CTN Members
100% participate in Injury Prevention Activities
50% have designated IP coordinator/specialist
Top 5 risk areas:
Motor Vehicle
Falls
Bike
Winter sports
Assault and Suicide
Results

31. 21 different IP programs (Stop the Bleed, Stepping On and Helmet programs most common)
59% hospital funded
Multiple challenges in supporting IP programs (time, resources, staff, funding etc.)
Results (cont.)

32. Suggestions for CTN’s IP subcommitee
Collaboration/ idea sharing
Mentorship
Introduction of new programs
Create online group and mass list
Develop annual or biannual state prevention campaign
Assist with funding sources
Suggestions for CTN’s IP subcommitee

33. Next meeting Thursday July 19,2018 10am-11am
Denver Health Pavilion H Public Health Dept. bldg. (corner of Bannock and 6th) 3rd floor conference room
Next meeting

34. Webpage Master Valerie Brockman Castle Rock Adventist Jodi Greenwood
St. Mary’s
Webpage Master

36. Trauma Registry