afternoon, everybody. Thanks for the opportunity to speak, and I really have to give most of the credit to the two outstanding members of our team, Beth, Therese, and Robin, who are here and are really going to tell the main part of the story for us, and I really can't do any of the things that we do at our trauma center without them and the rest of our team, so it's definitely not about me. Never is. So, first of all, again, myself, I'm the trauma program and burn program manager for VCU Medical Center. We're a level one trauma center in Richmond, Virginia. Beth Therese is one of our clinical nurse specialists and does a lot of our performance improvement, and then Robin is our trauma registry operations manager. I'm not going to read all these objectives. You can read them on the screen, and they're going to be in your handouts that will be uploaded to your website, and then just to give you a little bit more information about VCU Trauma Center, again, we're a large academic medical center in Richmond, Virginia. The MSA of Richmond, Virginia is about 2.5 million people, and we consider, or I consider ourselves an urban academic medical center for the most part, but similar to some of the other trauma centers that you all work at, once we get into our secondary catchment area, we get into a very rural area, and so we see some of the challenges of our patient care from our rural providers and from our outside hospitals that are our outside hospital partners, and I have to echo some of our other colleagues that have spoken today and yesterday about how that partnership with our outside hospitals and the appreciation of the resources that they have and do not have and how we can help tailor our partnership with them is critically, critically important to optimize the systems of care that we are trying to create across the country. Again, we have 15, we actually have 16 trauma surgeons. We have 25, or 22 APPs. I've got nine registrars and then Robin and then four clinical nurse specialists, and this is the distribution of our population between our trauma, our adult trauma, our pediatrics, and our burns. And as you can see from our trauma alerts, about 5,000 a year, and then our trauma injury-related admissions across the organization, the majority of our patients are blunt mechanisms, such as motor vehicle crashes and falls. We certainly have seen since the evolution of, or the increase in gun violence, I should say, and since the pandemic, an increase in our penetrating trauma. And we have a very small population of animal-related events overall. We do see some watercraft-related events because we're fairly close to the rivers and the ocean, but by far we're a blunt trauma center. And again, as you can see, a fairly small portion of animal-related incidences. We do have some horse farms near us and then out to the northeast of us, so we do get a lot of horse-related injuries and people falling and from events like that. I don't have to tell most of you in the room about what trauma is and the leading cause of death, but I think all across the country we have seen that rise in our geriatric trauma population or injury-related population, and we have certainly seen that increase over the 10 years that I've been at VCU Trauma Center. The demographics that have changed and not only the rise in our geriatric trauma patients, but the complexity of those injuries because we are living, I mean, I'm geriatric. I get a geriatric consult if I get admitted, which is really scary to me. But we are working really hard, and I think we all are working hard to see that. How do we improve the coordination of care for this very challenging and complex population who have been living a fairly functional life prior to their injury event or many times have lived a fairly functional life, but then because they are teetering on the edge physiologically, they really have trouble after they get admitted to the hospital. And so some of the things that we've done, and Beth will talk about that as we transition through. So I did have, you know, again, I said in VCU, at VCU and in Richmond, Virginia, we don't see a lot of animal events. There's not a lot of literature. I had the opportunity to work internationally in the country of Botswana about 12 or 13 years ago, and so animal events and trampling and wild boars were much more common. Elephants and other things, hippos. But we don't see a lot of that in this area. So there is high mortality and morbidity related to some of these larger animal type events, and pigs are no different. They're actually a fairly challenging animal to deal with if you work on a farm. As we know, rib fractures across all of our populations, especially the middle age and the elderly, are very challenging, again, because of the pain, the mechanisms of breathing, the mechanics of breathing, and then, you know, decisions, especially if you're in an area or a center that does rib fixation, the timeliness of that fixation and rib plating and what do we see are outcomes as far as lengths of stay on the vent and the overall outcomes. So I'm going to turn this over to Beth, and she's going to kind of tell the rest of the story. So as with the previous presentation, we do have permission from the patient to present all of the facts of this case. So I'm going to talk to you a little bit about this patient. He's an 85-year-old gentleman. His past medical history consists of hypertension, but at 85, that's of no surprise to any of us, as you might expect. He presented to a non-trauma designation after being trampled by pigs. Now, his perception then and his perception now is a little bit different. The report that he had given when he first came in, well, let me tell you how it came about. He was on the family farm taking a walk, and he decided to take a shortcut through the pig enclosure. So he stepped over the electric wire and into the encampment of the pigs, and I guess they decided they didn't want to share, and they decided to charge him. And as he recounts to me verbally, it wasn't this way in the EMR when he first came in, is that the first pig kind of took his nose, knocked him down, threw him up in the air, and he landed on his hip. So at 87, you can imagine what that is. And then if you know anything about pigs, anybody seen pigs on a farm? They've got nice, sharp hooves that they use for digging, and they make very classic lacerations when they trample or kick or stomp on the victim. So he underwent this. When he was walking, he had a walking stick, so he was able to, in his words, beat them off. So he was a feisty 85-year-old. He beat the pigs off, crawled under the wire to get out of the enclosure, and was able to get his phone out of his pocket and call 911 himself. They promptly arrived, well, got some help getting out. Any of you guys know what a mule is on a farm? It's not the kind with four legs. It's the kind you drive. So anyway, they were able to get back to him, get him loaded onto the mule, and then they rendezvoused up at the house with the rescue squad. So that was some information that, you know, at least when he presented to the outside hospital, they didn't have all of that other information. All they knew is that he had been trampled by four pigs. So that's the report that had initially come in. And he presents to the outside hospital because that is the closest one. When he initially presented to them, he was hemodynamically stable. If you consider 110 over 62 and a heart rate of 108, you know, for a geriatric patient, that's kind of marginal. But they still took him to that hospital and they did their initial assessment of the patient, started IV fluids on him. His SATs at that time were 88%. What do you think about that? So they put him on some oxygen and then expedited his transfer to a level one trauma center, and that's how he arrived to VCU. Maybe? The big green button, not the little one. Okay. So we got the report that the mechanism of injury was trampled by pigs. And if you get that as your basic information, all kinds of things come to mind. And as Beth said, you don't see this very often. And as I was doing a literature review, just out of curiosity's sake, because as you saw my disclosure, I'm a data geek, and so I like literature reviews. Anybody else like literature reviews and data? Yeah, some of us do. All right. But anyway, I found one case study of a trampled by pigs, and this is not wild pigs, boars, like Beth was talking about in Botswana, but this was domestic pigs. And if you've seen domestic pigs, they are very large and there's not a lot of literature out there. So this was kind of a unique case for us because we had not seen this kind of case presentation prior. So his mechanism of injuries, and some of these were diagnosed at the outside hospital. So we had pre-warning of what the patient had. He had a femur fracture. He had two rib fractures. He had a hemoneumothorax. He did not have a chest tube placed at the outside hospital, and that could have contributed to his low saturations. He had multiple lacerations to his chest wall, abdomen, buttocks, and wrist. And if you're thinking about being in a pigsty, you think, okay, well, that's not too clean a place to be. And you've got all of these lacerations, and some of them were deep lacerations. So he comes to us, and this is March of 22, so just to give you a little perspective there, he arrived as an echo. He was our lower level activation. We have echo level, delta level is our highest level of activation, and then we also have consult. So he came in as an echo because at the time he was relatively stable. He transferred, like I said, from the outside hospital. He was on four liters of nasal cannula, so they had taken him up, but he was 86% initially, and now he's on four liters and still 86%. So we knew that he was not responding to the oxygen as we would expect. He was also, if you looked at the patient, he was acutely short of breath and in acute distress, so they start their ATLS. So what they see in going through, they do the primary and secondary assessment. They see a left hip that is externally rotated. He's complaining of hip pain as well as pain on inspiration. He's got multiple lacerations. He's got lacerations to his gluteal. He's got a vertical to his right chest, and then he's got a deep posterior thigh laceration. His EFAST shows a hemothorax, and so what our team does is they put in a chest tube, and in that chest tube, they get out 650 mLs of bloody output, and his SATs improve to 98%. So that was an appropriate intervention. If you think about your ABCs, that goes under B, let's help his breathing there. And then they do a, you know, washout of his lacerations after doing his CT scans. We took him to CT scan, make sure there was not any internal bleeding, because that's certainly a concern of a fragile 85-year-old that has been trampled. What has happened? Does he have pulmonary lacerations? Does he have any internal bleeding because of where he had the external lacerations? But they did do copious washout of his lacerations and then closed them with sutures, and then because of his age and mechanism of injury, he goes to our surgical trauma ICU. So when you think about this patient and his injuries, you need to think about preventing morbidity and mortality. You've already heard multiple times in the geriatric patient how at risk they are and how large morbidity and mortality they have. So when we think about the femur fracture, we want to prevent the complications of that. We want to prevent hemorrhage. We want to prevent fat emboli, respiratory distress, and wound infection from that. And the good news is, at least in this case, it was a closed femur fracture and not an open femur fracture. So for the rib fractures, we want to prevent pneumonia. Pneumonia is one of the highest complications in the geriatric patient. About 48% of your geriatric patients that experience rib fractures will develop pneumonia. So you want to really work on that. They're at risk for respiratory distress, pulmonary embolism. He already had a hemopneumothorax, which we had addressed with the chest tube, but we want to continue to monitor that to make sure that it is totally evacuated. And then as has been stated multiple times, this is a team effort. We are blessed at VCU that we have a wonderful geriatric consult service, and we consult them on patients age 65 and older. Now for those of you that have facilities that start at age 55, I resemble that remark, because then that makes me geriatric. At 65, I'm not there yet, okay? But I did have to think about that when somebody was talking yesterday, and they were saying, oh, you're afraid of falls. And I'm thinking, hmm, I don't want to go in and be that fall risk, because depending on the facility, I would then be geriatric. But it does take a huge team, and for our patients, it starts in the emergency department. How many of you are emergency department people? You know, EMS is wonderful, the outside agency is wonderful, but it's their ER that really starts things. And so we have worked really hard with our emergency department to make sure that we are starting, particularly our rib fracture patients, on multimodals, and I'll talk a little bit more about that. But they start there, getting the appropriate consults, getting our orthopedics. They will respond to our highest level of activation, which is our delta, but they don't automatically respond to the echo. So getting those consults in in a very timely manner is important, because the sooner they can fix that femur, the better the patient's outcomes, and I'll talk some more about that in a second. We have our ICU provider team that accepts these patients and continues the care. We consulted geriatrics on hospital day one, so he came in in the evening, and by the next morning, our geriatric team had seen him. And had started that co-management, and you've heard a lot about the importance of geriatric teams and the impact that they can have. I was reading a study on the airplane out here, and this particular facility saw at one year a 46% decrease in mortality when they had that geriatrician helping to manage the patient in-house. So it has long-term impact on these patients, too. It's not just getting them out of the door and to a different facility. But what difference does it make six months, 12 months down the road? So they are a critical part of our team. We also tap into our acute pain service. We are very blessed that we have anesthesiologists that specialize in pain and help these patients to manage the pain. Our nursing is critical, because they're the ones that are with the patient 24-7, and we have done a lot of work with our nursing staff in how do we manage our patients that have acute rib fractures. Respiratory therapists, in the ICU, they are more integral for intubated patients. With this particular patient, he did not have to be intubated, so that was a good thing. When they move out of the ICU, if they have rib fractures, and depending on their condition, we will do a respiratory therapy consult so that they can evaluate and recommend treatment and help to co-manage that patient with the nursing staff, once they get out of the ICU. We also have orthopedics, and in this case, like I said, they were consulted from the emergency department and then took him to the OR on hospital day one to fix his femur. Early intervention there helps with getting them up and getting them mobile, and that's what PT and OT also help us to do. But they can't get that patient up with the broken femur. They're going to wait for that patient to be cleared to have activity out of bed. And so the earlier we can have those femurs repaired, the earlier we can mobilize those patients, get them up out of bed, get them up walking, and start to promote that mobility. In some cases, we may end up consulting a cardiothoracic service in those patients that have retained hemothoraxes. Depending on the timing, our trauma service will generally manage these patients and intervene if it's up until about day seven. After day seven, we look at, okay, does this patient need a different surgery or a different provider to do the surgery? And so sometimes we will consult our cardiothoracic service to help with the co-management of patients with chest wall trauma. And then inpatient rehab, you've heard multiple times about how important that is. And in this case, I'll talk more about that in just a second. So I mentioned pain management. We are very aggressive with our pain management. We start multimodal pain management down in the emergency department, depending on how long the patient is there. We try to get our patients out within two hours. And that may sound like a long period of time, but when you have capacity challenges, you know that sometimes the ED is boarding the patients. So we try to get a handle on the pain in the geriatric population. We want to minimize our opioids, so we will start the modals. But in this case, we'll start the acetaminophen, TID. And we try to schedule it so that the patient's not getting woken up in the middle of the night. Because how do you get a geriatric patient to develop delirium? You'll wake them up in the middle of the night. So we will monitor how we're scheduling our multimodals so that they're not being woken up at 2 a.m. and try to get them to have some sleep hygiene. Most of our patients that are not geriatric that have chest wall trauma, we will put them on a Robaxin. Now, is that the best thing for a geriatric patient? No, because again, what is one of the side effects that it can cause in geriatrics? Delirium. So for those of you that work in the ICU, you know you don't want your patients delirious. It makes them even more challenging to manage, as well as the fact that, you know, you lose some brain cells with that. And we don't want them losing any brain cells. But we found that in the geriatric patient, probably tizanidine is a better medication. And that is part of the recommendations that our geriatricians have offered to us. We will use gabapentin in the non-geriatric patient. If we use it in the geriatric patient, it's only to be able to use less opioids in that patient. But we try to avoid gabapentin in these patients, as well. Non-geriatrics, you will see that we use the multimodals of Tylenol, Robaxin, and gabapentin to try to get a handle on that pain and use less of the opioids. For this particular patient, because of the degree of pain with the rib fractures and the femur fracture, he was on a short-term regimen of a PCA. We had him on PCA. And then you can see his pain scores varied as he progressed. It really varied based on the activity. Of course, you know, the more we move this patient around, the more pain he had. But we try to really keep a hold of that pain. The pain consult was done on hospital day one. And they recommended a lot of cane drip. So he had that in addition to his multimodals and PCA initially. So we will throw a lot of things at them so that we can maintain that pulmonary hygiene. In our practice management guideline for pain, it's based on the ACS best practice guidelines. We do break it down into geriatric and non-geriatric. So our new providers, when you're working with residents, particularly the ones that come in July, they may not know, you know, the dosaging. And so we have practice management guidelines that help those to determine which which is the best dosing. Our nursing staff is wonderful. This is a sheet that we have outside of our rooms for patients that have chest wall injury. It has a what we call the modified PIC score. You may be familiar with the PIC score. P stands for pain, I stands for incentive effort, C stands for cough. So we modified it a little bit to fall in line with what we have in EPIC, so that we're all speaking the same languages, particularly when it comes to pain, whether it's control, you know, severe, moderate, or less intense as, you know, or controlled, I should say. It also kind of has a little care guideline down on the left side to say, okay, have we done all the things that we said that we're going to do, that we've got delineated in our practice management guideline, but, you know, have we done all of these things to help our patient optimize their pulmonary hygiene status? And so the nurses, when we round, will look at this with the team and say, okay, this is where our patient currently is, and we can find out how are they doing with that. If they have a weak cough and poor incentive effort, is it because that we don't have control of the pain? What's the next level that we need to take for that? So in this particular patient's case, just to go over the course with you, hospital day one, he gets admitted to the ICU. Hospital, excuse me, hospital day zero. Hospital day one, he gets his femur fixed, so timely fixation of that femur. Hospital day three, because the femur is fixed and we've got control of his pain, we start mobilizing this patient. We get him up out of bed and mobilizing the patient. And then hospital day five, he's transferred from the ICU to the floor. We get the respiratory consult out on the floor to help continue to manage that. He still had his chest tube at that point, so he was still having some significant pain in that side because of that. We put his chest tube to water seal, still having a little bit of residual pneumothorax, so we consulted our cardiothoracic surgery team to say, okay, do you have any other recommendations? Is there anything else that you would recommend that we do to help this patient? They did not have any other interventions. We were able to pull his chest tube on hospital day 10. And then hospital day 11, he is transferred to an inpatient rehab center where he spent two weeks rehabbing. And then he was able to go back to his assisted living where he had come from. He lived in assisted living. He was able to go back to that and continue PT and OT there. And he continued that for about another month, at which point he was able to again walk with his cane and he was able to go back to driving. So this is Tom, and he allowed me to take these pictures. This is from last month. So he was extremely pleased that we were using his case, that he even sent me a document with his perspective of the event, providing me with some additional information. But he's a cute, cute little man and just adorable. But you know, for an 87 year old, he says, I'm doing okay. I'm still moving. So I'm gonna turn it over to Robin, and she's gonna talk to you briefly about how we take our patients and use that information to drive clinical practice again. Okay, so obviously I have currently nine registrars, and their job is to abstract data and make sure that it is accurate and that it is quality data. And so I validate a good majority of the data that they put into the registry. And then obviously run lots and lots of reports, analyze that data, and then revalidate things that I find in those reports that don't make sense. And then I have a ton of dashboards. Okay, so looking at this patient and this patient's injuries, you see he had a femur fracture, as Beth talked about. He had a femur fracture, some rib fractures, a hemopneumo, and lots of lacerations. And as you see, his ISS is only a 19, which gives him a really good probability of survival. And again, we validated all of these injuries and our AIS and ICD-10 coding on this patient. And again, the one limitation of our ISS is that you can't count. He had two injuries in the chest, and obviously we can't use both of those for his ISS scores. Looking at his probability of survival, though, doesn't also take into account his age and his comorbidities when you're dealing with a geriatric patient. So sometimes that's not always the best predictor. So one of my dashboards that Beth and I developed together is our chest injury dashboard. So we actually look at our chest injuries and pull out our data, and we want to know what is our median age. And as you can see from this, it's right around 60 for those chest injuries. And then we look at our ISS ranges to see what percentage of our patients fall into what ISS range. Again, also looking at how many of our patients had a cardiothoracic consult with an intervention. So some of them may have had a cardiothoracic consult, but no intervention. And then we are looking also at what are the differences when a patient does have rib plating and when a patient doesn't have rib plating. And you can see there that even the mortality, the difference in mortality when our patients do have rib plating, we look at their ICU lengths of stay, all kinds of data. And of course, this actually goes out to, we have a chest wall injury team. So the data goes out quarterly to that entire team so that we can look at all of our patients that have our chest wall injuries. So from the data that we analyze related to our patients, we institutionalize or memorialize these care changes or in practice management guidelines. And I think everybody probably has some type of, you know, practice guideline that they use. But we take this data and then look to see, okay, do we need to change how we're practicing? And then so that we have that institutionalized, we will create these guidelines. We have the rib fracture practice management guideline that we did in 2018. And that helped us to triage our patients. When they come in, where do they need to go? Because initially we found out that we were putting all of these patients in the ICU. And with the critical bed shortages in the ICU, we needed to have a better way to do that. And so we created a triage algorithm, tested it, and then put it into practice. And it has, you know, worked very well for us without an increase in unplanned ICUs related to these types of patients. We created the chest wall injury team so that when patients like, you know, Tom come in, that they evaluate those rib fractures to see how displaced they are and whether or not the patient would benefit from rib fixation. If they meet the criteria for rib fixation, then our goal is to have it done within three days. Tom's rib fractures did not meet criteria. So he did not have rib fixation. What we have found is if we do it within three days, we have better outcomes, shorter ICU length of stay, shorter hospital length of stay. And one of the interesting statistics that we saw was, you know, fewer of our patients went to nursing homes. So that was, you know, a good outcome for the patient. It wasn't necessarily statistically significant, but it was a good outcome for the patient. And these guidelines also tell us, you know, again, who's an operative candidate, who's not. And then we use our practice management guideline for pain management to try to get control of the pain, as I mentioned earlier. So I'm going to pass it down to Beth. She's got one. Yeah, so I think as Beth said and Robin talked about it and other speakers today and yesterday have talked, our TQIP data is a living document for us. This is not something that we get the report every six months. We look at it and we either celebrate successes or we have seizures over where our opportunities are and then hide it. So we really believe that this is a document that should be shared across everybody on our team. So we talk about it with our registry team. We look at different aspects of our data and data collection and validation. We share it with all of our trauma surgeons and we share it with our teams including our bedside staff nurses from our emergency department through our ICUs and continuum of care because it's about owning how well we do and where we again have our opportunities. And I think that this is, I've been at VCU now for 11 years and I did have a little bit of a seizure the first TQIP report we got or I got when I was at VCU and I was like oh we might have some work to do. And but I think it's really been a journey and if you can press the button, oh sorry, it's really been a journey for us and you have struggled sometimes and you seize the opportunity to make little refinements. So every time you see an opportunity you may make little refinements. It doesn't have to be a huge organizational you know PI improvement where you spend six months developing a process map and and all these other things that you take on little tiny incremental changes and they can make sustainable improvements over time to see that. And then as you see you know vulnerabilities I think many of us again saw a lot of challenges during the pandemic with our nursing resources, operating room, some of our changes in practice and other things and we really seized the opportunity to say was that the sole reason that we had some challenges with some of these populations or did we actually did we actually have changes that are in care and are in practice. And I think that's where partnering with our geriatric in this population or for this patient in particular making sustainable changes very incrementally over time with our physical and occupational therapists, with our rehab teams, with our geriatric teams, the timing to our rib plating, developing teams specifically for our rib plating patients in the operating room, etc. are all making improvements over time and that's where we see the change in the trend line improve. So we'll take opportunity or we'll take questions now so. So I just want to say I saw a couple faces here at our TQIP report. That has been a lot of hard work. Okay it hasn't always looked like that. It's been a ton of hard work by a lot of people to get it there. So this this this report we were actually able to celebrate a lot of successful things that our entire team and that means the entire continuum of care has made for our patients. It's my face that she was talking about just so we're all really clear on that. You mentioned that you share your TQIP report across you know with the bedside nurses, with the ED. How do you share it with them? Is this in your systems meetings? Is this via targeted education going down there and meeting at different times of day? And what kind of feedback do you get from your bedside nurses about this? Because every time I share my TQIP report I'm having to re-educate everybody on okay this is what this cohort means. No injury you know your isolated hip fractures really are isolated. They can't have any other injuries. They're not part of the all patients cohort. This is a specific definition for AKI. This is a specific definition for this. And so how do you keep up to date on making sure everybody truly understands that data and how are you getting out to them and what's your feedback? Yeah I'll speak to that question first and Beth can Robin can share a little bit too if they want to. So first and foremost we do share it at our systems meeting. We share it with it first we share it with our attendings and our attending meeting. We share it at our systems meeting. We do have some subcommittees as part of our trauma center. So we have a trauma resuscitation committee that is really focused on just systems structures and processes related to our resuscitation bay with our emergency department nursing teams and attendings the ED attendings. So we do share aspects of the report with them and then we also the the nursing team in the emergency department has our resuscitation meeting or a team lead meeting. So we share some aspects of that data. So we're trying to celebrate the success and we don't necessarily always have to go into every single nuance of some of that but where we have some opportunities then we try to drill down and explain it in smaller groups. I attend the Department of Neurosurgery Morbidity and Mortality Grand Rounds and then one of our attendings attends the Anesthesia Grand Rounds and I sometimes go to that also. So we try to we try are very hard to do that on a regular basis at least once a year if not every six months as well. Literally we have a quarterly sort of leadership discussion with our orthopedic trauma division that was just last week. So all of the orthopedic metrics were shared with them as well as our current dashboard and metrics to talk about again just little tweaks and sometimes big changes that need that potentially need to be made. And then with our ICU aspects we have an ICU aspect of our dashboard so we share the ICU metrics as well as what our current state looks like for our ICU leadership both nursing and physicians and they have a collaborative practice. So we're trying to disseminate it we do have to do some re-education and then where we have some opportunities like we do have some challenges right now with length of stay with our ICU length of stay timeliness of you know weaning and that's where we're using and driving some of that change with our respiratory therapy and our ICU staff to get metrics for SBT and SAT and then how long does it take us to actually get that patient extubated so that we can really try to reduce our length of stay in the ICU and our vent days. So we try to make it as living as possible and then as Robin said she uses it with our the registry team to to really sort of pick out sections and areas where we've had some maybe some opportunities in our data and do education do peer evaluation and remedy or peer validation and use it as a learning tool more than you know a remediation tool I guess. With the registry team what I found and I found this across the country from registrars is that there are a lot of teams that do not share the benchmark report with the registry team. It's important for them to understand the data that they're putting in where it's coming out. Super important because they're not data entry people which sometimes people peg them as well their data entry they're not data entry. They're putting in there it's coming out and if they're putting in good quality data you know that benchmark report is showing you how your center is doing. If they're not you you can have a benchmark report that means nothing because the data is incorrect. So going over it with them use the TQIP education portal for them make it mandatory that they do all of the learning on the benchmark report so they understand how to read it what it means what it's showing. Super important for them to have to do those things and in that education portal every year by the end by June 30th they are required not only obviously their monthly TQIP quizzes that come out those are required but they're also I have them also doing the yearly their annual you know quiz or test or whatever it is they're learning and then also those benchmark that benchmark learning they don't they don't you know many of them are like I don't know how to read this so again next this this coming month we will spend our registry meeting going over the the benchmark report showing them the code sets that come back showing them the resources what are the cohorts mean super important for them to understand the entire benchmark report so they know you know wow this really does mean something this data I'm entering the coding how important is the coding it has to meet those code sets so it's really important again to make have them understand all of them what what the data is that they're putting in the registry and then as the nurse clinician I get myself on the agenda for the emergency room resuscitation Bay monthly meeting I go to that every month and then I also get myself on the agenda for the ICU collaborative meeting so that I can go to them and the data that we pull out of the registry I can share that with them in real time because we know that teak whip is a lagging indicator I want them to know how are we doing now what are the current things that we're asking them to do and what difference it makes because they want to know that what they're doing at the bedside is making a difference you know particularly in the ED in the ICU where once the patient leaves those areas they may not know what happens to that patient so that's where because I look at them across the continuum I can share that information with them and help them to see how they play an integral role in outcomes and how those outcomes make a difference overall for our organization and our patients other questions that you might have well thank you for your time yeah I just think I'll just make one comment I think I learned this a long time ago and some adult learning theory class that I had to take that there's a there's a knowledge or cognitive aspect to it there may be a psychomotor aspect to a learning to a skill and then there's the effect there or the behavioral aspect of it and I still remember this instructor got rest their soul that she said you know a person can smoke but and you can tell them all the time and you can give them all the data that you want but they're gonna keep smoking until there's an effective change or a mindset change and so I think that that I've taken that Irene Powers but I take that and I think about how do we create the if the affective aspect of why this is important into our patient care and part of our data too so it's not just the knowledge of what does it what is a rib fracture or why do we have to you know why do we have to start this or why do we have to do it this way but then it's that it's that affective aspect and I think this is the part that I'm sharing that is also what contributes to it thank you very much

collaborative effort

data-driven practices

VCU Medical Center

trauma center

patient care

continuous education

feedback loops

registry team