Timeliness of Management of Trauma Related Hemorrhage and Trauma Related Coagulopathy

项目总结

PROJECT SUMMARY Injury is the most common cause of death in people younger than 46 years of age, and bleeding after injury is the most common cause of preventable death. Treatment of bleeding requires timely procedures to stop the bleeding as well as medications and blood transfusions to prevent blood thinning. Hospitals that specialize in treating injury have protocols, medications, devices and clinical staff available 24 hours a day and seven days a week. Injured people treated at specialized hospitals are more likely to live. However, there are far too many injured people every year than can be treated at specialized hospitals so minor injuries are cared for at hospitals not specialized in treating injuries. Severely injured people are taken to hospitals not specialized in treating injuries when specialized hospitals are too far away, or the emergency medical personnel underestimate how seriously injured someone is. Hospitals not specialized in treating injuries do not participate in ongoing injury clinical trials, regional data registries nor national quality improvement programs, and as a result what happens there that leads to people bleeding to death is unknown. This application's long-term objective is to improve the timeliness of treatment of bleeding after injury. The Specific Aims will be to: 1) understand how bleeding after injury is managed in hospitals that do and do not specialize in treating injuries; 2) identify the reasons patients do not get timely treatment; and3) determine how to improve the timeliness of treatment. The central hypothesis is that treatment of bleeding is not standardized in hospitals not specialized in treating injuries and leads to a delay in transferring injured people to specialized hospitals. Identifying modifiable healthcare system, hospital, and patient factors can inform the design of a systematic process to quickly temporarily stabalize bleeding of injured people initially at non-specialized centers then expedite transfer to specialized hospitals by engaging key stakeholders from across the spectrum of hospitals. This will ensure that people who are bleeding after injury are cared for at the right place at the right time. Ultimately, the right treatment at the right time will give people initially taken to hospitals not specialized in treating injuries the same chance at life as those taken to specialized hospitals. As a Career Development Award, the proposed training plan will include training in data science, systems engineering and design. The methods to be learned and employed will be machine learning, failure mode, effects and criticality analysis and user-centered design. The health relatedness of the project is to understand current practice management of bleeding after injury, in order to improve the timeliness of bleeding treatments to enhance the health of injured inviduals.