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Operative Triage of the Trauma Patient (2.29)

Operative Triage of the Trauma Patient (2.29) - Policies, Clinical, UWHC Clinical, Department Specific, Surgical Services, Clinical

2.29

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

MAY 1997
ORIGINAL
 REVISION

MARCH 2017
PAGE 1
OF 3
POLICY #

2.29
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Operating Room
TITLE
OPERATIVE TRIAGE OF THE TRAUMA PATIENT


I. PURPOSE

To describe a mechanism for utilizing an Emergency Department (ED) Trauma Bay as a trauma OR in the
event that a trauma patient requires emergent surgical intervention and the OR is at maximum capacity.

II. POLICY

A. The OR Charge Nurse or designee will report to the ED Trauma Bay for all Level I traumas as
outlined in OR Policy #1.12 “Trauma Patient Communication”.
B. A member of the Trauma Team will notify the OR Charge Nurse or designee if the patient needs to
go immediately to the OR for any level of trauma response.
C. An ED Trauma Room will be made available to facilitate the Level I trauma patient and the OR
response to traumas.
D. The OR Charge Nurse will triage cases/rooms with the anesthesiologist in charge (see OR Policy
#1.26, Staffing Plan - Operating Room). The on-call anesthesiology resident is part of the Level 1
page, required to respond to the ED before patient arrival. If a trauma patient requires immediate
surgery, the OR Charge Nurse will notify the Anesthesia Coordinator of the day.
D. The Trauma Team will transport the patient from the ED directly to the OR designated trauma
room, as directed by the OR Charge Nurse. The ED primary trauma nurse will facilitate continued
resuscitation and patient monitoring until relieved by the OR staff. The ED nurse will provide a
brief patient report to the OR staff, including vital signs, history, if available, mechanism of injury,
and interventions performed.
E. In the unlikely event the OR is unable to accommodate additional emergency trauma cases, the OR
Charge Nurse will inform the trauma attending that an ED Trauma Bay will need to be used as an
OR for the trauma patient. The trauma attending will notify the ED attending and ED Care Team
Leader. . The OR Charge Nurse will notify the Anesthesia Coordinator of the day (7 AM - 4 PM),
or the first call anesthesia faculty if after 4 PM. Anesthesia will respond to a Trauma Bay with the
standby anesthesia machine.
F. The OR Charge Nurse or designee will bring the necessary OR emergency case trauma cart to the
ED Trauma Bay. This cart includes major gown pack, suture, instrument pans, drapes, and other
essentials. The OR will bring an electrosurgical unit machine and facilitate with anesthesia to bring
necessary anesthesia equipment and supplies. The OR will activate its on-call mechanism to access
additional staff as needed. OR staff will respond to the ED Trauma Bay.
G. All staff entering the Trauma Bay will be attired in scrubs and don a hat and a mask. Surgical team
members will scrub at the sinks adjacent to a Trauma Bay. Staff will sign in upon arrival to the ED
Trauma Bay.
H. The OR team will set up the case and act as the scrub and circulating nurse The OR team will

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

MAY 1997
ORIGINAL
 REVISION

MARCH 2017
PAGE 2
OF 3
POLICY #

2.29
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Operating Room
TITLE
OPERATIVE TRIAGE OF THE TRAUMA PATIENT


document the surgical procedure performed in the ED Trauma Bay as per standard OR protocol.
I. OR charge RN will stay in contact with the ED Care Team Leader in the event the patient would
need to transfer to the OR.
J. In the event that the ED is used as the location for an emergent operation, a Root Cause Analysis we
be completed to determine if use of ED as OR was appropriate will be conducted with the following
people (At a minimum, additional participants will be included as appropriate):
a. Applicable (Adult or Pediatric) Trauma Program Manager
b. Applicable (Adult or Pediatric) Trauma Medical Director or designee
c. ED Nursing Director or designee
d. ED Medical Director or designee
e. Surgery Attending involved in case
f. OR Medical Director or designee
K. The following procedures will be exempt from this policy:
a. Emergent central venous line placement
b. Arterial line placement
c. Emergent tube thoracostomies
d. Emergent surgical airways
e. Emergent resuscitative thoracostomies

II. EMERGENCY DEPARTMENT STAFF ROLES

A. The ED primary trauma nurse will assist with opening the sterile field as directed by OR staff and
act as circulator while the OR on-call personnel are en route.
B. ED Nurse(s) chart within Health Link via the ED Navigator until incision is made. The Emergency
Department Coordinator, EDC, will admit the patient to the OR in EMR at time of incision. After
incision, the OR nurse will assume responsibility of charting.
C. OR documentation will begin at the time surgical incision is made utilizing the ED computer
workstation in the trauma bay. ED staff will assist with obtaining and sending labs, locating
supplies in the Trauma Bay, and procedures as requested by the surgical team.
D. ED Charge Nurse will control access to a Trauma Bay, coordinate communication, and assist in
obtaining supplies and equipment as requested by the surgical team.

REVIEWED BY
ED Clinical Operation Committee 12/2016
Adult Trauma Operations Committee 12/2016
Pediatric Trauma Management Committee, 12/2016
Suresh Agarwal, MD 12/2016

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

MAY 1997
ORIGINAL
 REVISION

MARCH 2017
PAGE 3
OF 3
POLICY #

2.29
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Operating Room
TITLE
OPERATIVE TRIAGE OF THE TRAUMA PATIENT


Denise Dillon, 12/2016
Benjamin Eithun, 12/2016

SIGNED BY

Anne Mork, MHCDS, MS, RN 3/2017
Interim Director, Surgical Services