In February 2019, Claire, a Critical Care Outreach Sister, and Patient Safety Learning's Associate Director, had the great privilege to visit Rush University Hospital, Chicago, as a visiting nurse scholar to shadow the critical care outreach team. The objectives of this visit were to (1) collaborate to harness and direct the strengths of two teams from two different countries, in two unique settings; and (2) to promote best practices that facilitate early recognition and management of patient deterioration to improve patient outcomes.
In this blog, Claire talks about this amazing opportunity to see how the UK and USA systems differ and how we can learn from one another.
Day 1 – a visit to the Cook County Trauma unit
On our first day, we were warmly welcomed by the Director of Critical Care, Director of ED, Trauma Lead and Intensive Care Manager, at the John H. Stroger Jr Hospital of Cook County. This is a public hospital in Chicago, Illinois, with a level 1 trauma unit, and is one of the most respected. The hospital's emergency rooms treat approximately 120,000 patients every year; 7,935 of which were trauma patients last year. It also served as the setting for the US television hospital drama ER but we didn’t see anyone fitting George Clooney’s description, sadly!
We were lucky to get a tour of the emergency rooms. Cook County has two emergency rooms. One for trauma/burns and one for standard emergencies.The trauma emergency department (ED) is for trauma only (obviously). Patients first arrive and go to the ‘shock room’ where they would have a primary survey and any interventions such as thoracotomies, chest drains, etc. As soon as possible the patient would get sent for a CT scan. 65% of the traumas seen in this ED are gunshot wounds and stabbings, around 56% of traumas will be admitted and carry a <2% mortality rate.
The most interesting aspect of the pathway is the nursing. "Continuity of care is of great importance here." The patient is admitted via the trauma ED, the admitting nurse will then follow that patient all the way through that admission to trauma intensive treatment unit (ITU) and then on to the step down ward where they may be discharged. Quite often patients are discharged home from the trauma ITU. The nurses are trained to work in all ITUs. This serves of great benefit for the patient and pooling resources so demand can be met. The ITUs consist of cardiac, trauma, medical, surgical and neuro; there is not a ‘general’ ITU.
"Care does not stop when the patient is discharged." Trauma surgeons care for the patient when they come in until the patient is discharged home and will also see them in their follow-up clinic, which is part of the trauma ED. Patients are also seen by a clinical psychologist and a trauma practitioner. The trauma practitioners have links with external agencies who can assist with rehabilitating patients that may be involved with drugs, gangs, assist with housing, schooling and employment. Cook County hospital understands the community it serves, 40% of which do not have insurance, and they treat all who turn up regardless of status.
We met Becky, the Trauma Lead for Nursing, and Dr Bokhari, Attending Trauma Lead, both were thrilled to see us and very keen to collaborate/share practice with us. Yet another opportunity that we should not pass up. We have so much to learn from their practice and "the perfect opportunity to shape new trauma services in the UK..."
About the Author
Claire is an experienced nurse of over 20 years. She has worked in numerous specialities in the NHS and in different places around the world, from being a repatriation nurse to volunteering in refugee camps and striking up collaborations with nurses in the USA. Since 2011, Claire has worked as a Critical Care Outreach Sister where her desire for patient safety was ignited.