1. Trauma Service Overview

Orientation materials and additional information regarding work flow and requirements of the trauma service to help improve your experience and set expectations.

Daily Floor Rounding Checklist for Trauma Patients

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Important Phone Numbers and Contact Information

Acute Care Surgery Attendings:

Attending Pager Cell Office
Zachary Bauman, DO 402-888-1131 712-251-0895 402-559-4714
Joseph Baus, MD 402-888-1800  614-975-5466 N/A
Christopher Barrett, MD  402-888-6080 651-497-7846 402-559-3335
Bennett Berning, MD 402-888-5527 312-208-7465 402-559-4706
Keely Buesing, MD 402-888-0563 402-312-0984 402-559-8908
Emily Cantrell, MD 402-888-1201 336-775-8889 402-836-9142
Mark Carlson, MD  402-888-5161 402-650-4219 402-559-4581
Samuel Cemaj, MD 402-888-1203 402-305-5809 402-559-7166
Charity Evans, MD 402-888-0525 312-231-0897 402-559-2101
Matthew Goede, MD 402-888-3770 402-881-7345 402-559-8736
Mark Hamill, MD 402-888-5484 843-324-8252 402-559-3048
Joshua Jaramillo, MD  402-888-6059 720-363-1449 N/A
Abigail Josef, MD 402-888-5525 402-715-0029 402-559-4567
Andrew Kamien, MD 402-888-1453 716-228-0118 402-559-7399
Kevin Kemp, MD 402-888-2545 510-378-2215 402-559-8147
Mike Matos, DO  402-888-5655 304-482-2712 402-559-7051
David Mercer, MD 402-888-3758 402-889-3431 402-559-8272
Olabisi Sheppard, MD 402-888-5034 913-271-7241 402-559-2113
John Tierney, MD  402-888-6079 480-703-4556 402-559-1866
William Terizian(Hillman), MD 402-888-5526 703-505-1058 402-559-5970
Jessica Veatch, MD  402-888-6154 303-726-0736 402-559-8979
Brett Waibel, MD 402-888-0698 252-414-8586 402-559-6809

Acute Care Surgery APPs 

APPs           402-559-7901 / 402-559-9589 / 402-559-8142
Tim Baack, NP 402-888-5843 402-640-4084
Jessica Bachmann, NP 402-888-6252 402-660-4017
Maggie Baumann, NP 402-888-3839 402-813-4519
Christina Boje, NP 402-888-1871 402-578-7219
Samantha Cunningham, NP 402-888-5101 402-250-8711
Sam Dellinger, PA  402-888-6190 402-332-8474
Esthefany Estrada,  402-888-5155 308-325-8504
Kelly Fenn, PA 402-888-1440 563-299-5585
Abby Hager, NP 402-888-5582 402-680-9465
Patrick Heavey, PA  402-888-5675 402-699-9119
Kristin Johnson, NP 402-888-4584 308-530-5183
Sophia Ketchmark, PA 402-888-6189 402-926-6229
Shannon Landry, PA TBD  TBD 
Ashley Lewis, NP 402-888-4072 402-452-7660
Sonia Malik, PA 402-888-6008 703-994-2553
Evan Meysenburg, NP 402-888-6083 402-741-0970
Erin Panowicz, NP 402-888-5089 402-416-1274
Whitney Petersen, NP 402-888-0097 402-984-3744
Meredith Reittinger, NP 402-888-5865 336-549-2644
Dom Samuel, NP 402-888-1698 402-541-8998
Amber Saltsgaver, NP 402-888-5153 402-651-1250
Megan Samland, NP 402-888-5597 402-350-3564
Emily Ulmer, PA 402-888-6124 308-870-4515
Theresa Vergara, NP 402-888-2443 646-498-3829
Makaela Waddell, NP 402-888-0303 402-536-9460
Becca Witt, PA 402-888-5846 402-250-2134
Cassey Younghans, NP 402-888-6084 308-870-0791

Acute Care Surgery Administrators

Administrative
Jeannie Thomas 402-559-9696
Jessica Bruno 402-559-8884
Savannah Reyes  402-559-5248
Sue Cramer 402-559-9225
Karen Kroupa  402-559-9960
Copy Machine Code: 10278
Conf Room Code: 51243

Acute Care Surgery Inpatient and Outpatient Team Contacts

Inpatient Team Contacts
Molli Kies, Care Transition Nurse 531-557-1135 402-559-6145 402-990-0874
Angel Erwin, Care Transition Nurse 531-557-0827 402-5522738 402-650-3038
Ginny Rogers, Peds Care Transition Nurse 531-5579166 402-552-2505 402-917-2593
Barb Robertson, Nutritionist 402-888-1848

Dennis Brown, Care Transition nurse for EGS 402-552-6588 402-981-9431 531-551-5031
Social Worker 402-888-1643 402-559-6145  531-557-3822
Elizabeth Hawkins, Pharmacist  531-557-7456 402-714-2787 402-552-3541
Alli Gabriel, Pharmacist 402-637-6454 402-552-3965 531-557-3983
Ashley Farrens, Trauma Prog Manager
402-612-7702 402-552-3997
Stacey Roode - PI Coordinator
402-618-0375
Liz McIntosh - PI Coordinator
714-651-7733
Kayla Petersen - PI Coordinator
515-729-9289
Lora Hofstetter - Peds PI Coordinator
913-709-0923
Brian Lake, 9N Manager 402-552-3873

Chad Himmelberg, SICU Manager 402-552-7963

Outpatient Team
Jenn Dickey, Case Manager 402-888-3629 402-672-6081 402-559-6075
Clinic Scheduling (# for pts) 402-559-4075

Clinic 402-559-4737

Clinic Workroom 402-559-2028 

     Trauma Clinic: Mon & Thurs @ 1-3pm


     EGS Clinic:  Wed @ 1-3pm


     Elective EGS Clinic: Thurs @ 9am


Service Pager and Consultant Contacts

RED TRAUMA TEAM PAGER: 402-888-1938

GREEN SICU Pager: 402-888-0282
Blue APP TRAUMA TEAM PAGER:  402-888-4774

YELLOW CCS TEAM PAGER: 402-888-3005
EGS PAGER: 402-888-0447

General Surgery/Night Float Pager:   402-888-0316
Orthopedic Surgery Pager: 402-888-0586
Neurosurgery Pager: 402-888-1866
Pediatric Surgeons Pager Cell Office 
Angela Hanna, MD N/A 801-550-4482 N/A
Abdalla Zarroug, MD N/A 507-271-5656 N/A
ENCOMPASS TEAM 
Ashley Raposo, Program Supervisor  402-559-9154 402-980-1731 (cell)
Melissa Inzauro, Social Worker  N/A  402-250-6336 (cell)
Allie Sothan, Social Worker N/A 531-375-8334
Tia Manning, Mental Health Specialist N/A 402-250-9813
Violence Intervention Specialists 
Kam Wayne N/A  402-250-4324 (cell)
TiShara Wardlow  N/A  402-830-7986 (cell)

Departmental Contacts

Department Contacts
Handheld/Battery-Powered Bronch  OR RT   402-559-1615 402-650-5748
Anesthesia CD 402-559-4078 / 402-552-3224
OR 402-889-0931
OR Charge 402-559-9900 / 402-552-3224
Scheduling 402-559-5257
Preop 402-559-9087 / 402-552-3288 (CCE)
PICU 402-559-1420
Anesthesia 402-552-2090
Micro 402-559-5031
Psychology 402-559-1030
Lab 531-557-3980
ICU Pharmacist 531-557-7452
SDCC Pharmacist 402-559-7235
Inpatient Pharmacy 402-559-6502
Trauma Bay 402-559-4583
ECHO 402-559-6694 / 402-559-6637
ER 7-3600
ED Charge Nurse 402-559-1000 / 402-559-3216
Radiology Dictation 402-888-1898
Radiology Resident 402-559-8953/888-1314/888-1415(res)
IR 402-559-8953
Radiology Reading Rooms
     Body CT:  402-559-1005
     Neuro: 402-559-1008
     Bone: 402-559-1006
     US:   402-559-1023
     Nights: 402-559-1233

Isolated Orthopedic Transfers to Bellevue Medical Center Requiring Joint Replacement


Purpose:

·         To Identify which patients can appropriately be transferred to Bellevue Medical Center (BMC) who have sustained an isolated fractures requiring total or partial joint replacement

Background/definitions:

·         Lack of OR availability at Nebraska Medicine main campus for partial or total joint replacement in trauma patients has put a strain on the system and delayed definitive surgical treatment for these patients. 

Guideline Inclusion Criteria:

Guideline Exclusion Criteria:

Diagnostic Evaluation:

Practice Recommendations for Management:

  1. If patient requires fixation via a partial or total joint replacement, is deemed appropriate for transfer to Bellevue Medical Center (BMC) by the Trauma Service, and has an accepting physician, the patient will then be transferred to BMC from the NMC ED for further isolated fracture management.  BMC hospitalist is the accepting primary service for BMC transfer and ensures appropriate medical resources are in place for patient to be cared for at BMC. (Example- If patient has a hip fracture but is ESRD on dialysis, patient stays at NMC)
      •  Transfer to BMC will be arranged by the Orthopedic Surgery resident by contacting the PPU (aka BMC bed desk, 402-559-2337) and requesting transfer to the BMC hospitalist service.
      • PPU informs Ortho resident of approximate inpatient BMC bed wait time.
      • If there is an inpatient bed wait time at BMC, patient is sent to BMC Pre-Op as long as a same day BMC OR time can be assigned.  If BMC OR time cannot be assigned the same day, patient is prioritized to BMC inpatient bed with all BMC ED admissions, the purpose of this prioritization is to transfer patient out of NMC ED expeditiously.
      • No admission orders are placed to admit the patient to NMC.  While the patient awaits transfer to BMC in the NMC ED, Trauma service continues to care for the patient.
  2. If Orthopedic Surgery resident determines patient would be more expeditiously cared for at main campus due to BMC bed wait
      • Trauma service is contacted again and admits the patient.
      • Trauma or Ortho provider contacts HM surgical co-mgmt service for pre-op evaluation and medical co-mgmt.
  3. If prolonged inpatient bed wait at both BMC and NMC campuses, On-Call Trauma attending and On-Call Orthopedic attending (& if needed BMC hospitalists for medical needs) determine whether it is best to transfer to BMC versus admit to NMC.  PPU can help coordinate the conference call on the rare chance that all 3 physicians are needed to determine best location.  Once location is determined, follow steps outlined above in A. to transfer to BMC or B. if admitting to NMC.

Follow-up Care:

Outcome Measures and Guideline Adherence: 

Key Contributors:

·         Zachary Bauman, DO, MHA

Last updated:

·         1/16/2023

References:

·         American College of Surgeons 2022 Trauma Standards

Reimplantation Triage and Transfer Pathway

Reimplantation Triage and Transfer Pathway

Purpose: As an American College of Surgeons, verified level I trauma center, we are responsible for thorough assessment of the traumatically injured patient. This document is to aid in the triage and transfer process of patient requiring reimplantation services.

Background: Nebraska Medicine has multidisciplinary coverage (orthopedics, plastics, vascular, and urology) for patients requiring reimplantation services for traumatic injury (ie: severed limb, digit, or other body part).

Please reference the three identified injury types for appropriate treatment plan:

Mangled Extremity

Treatment of a mangled extremity is a collaborative effort amongst the Trauma service, Orthopedic surgery, and Vascular surgery.  When a patient is determined to have a mangled extremity or extremity requiring re-implantation, all three services are involved to determine the overall best course of action for the patient given other injuries, hemodynamic status, and the ability to salvage the extremity.  We utilize a mangled extremity score (see table below) to help with this management decision.  Once all three service lines have agreed to re-implantation and/or attempting to salvage the extremity, the patient is taken to the OR where Orthopedic surgery and Vascular surgery will re-attach/re-construct bones and vessels as needed. Both services are available and on-call 24/7.


Upper Extremity/Hand Re-implantation

 Nebraska Medicine has three experienced hand surgeons that are willing and skilled to perform hand/digit reimplantation when they are on call.  Unfortunately, between the three of them, they cannot cover the hand service 24/7. 

When these surgeons are unavailable, calls should be made to transfer to our regional implantation centers. See list of resources with contact information.

Our usual workflow for this is when we get a call from an outside hospital wanting to transfer a patient to us who potentially needs a hand/digit re-implantation, we will do a conference call with our on-call hand surgeon to see if this is something they are able to care for at our institution.  If they are, we will have the patient transferred.  While the patient is in route, our hand surgeon will get the OR organized and ready to go when the patient arrives.  If the patient is unable to be cared for at our institution, we will help the outside hospital coordinate care to the regional hand re-implantation center by providing phones numbers and contact information.  The same process applies if the patient comes to our institution directly from the field.  Our on-call hand surgeon will assess to see if this patient needs to be transferred or not (not all our hand surgeons do re-implantations).  

 

University Hospital – University of Missouri Health Care

1 Hospital Drive, Columbia, MO 65212

1-573-882-6985 - line 1

1-573-771-7860 – line 2

 

University of Iowa

200 Hawkins Drive, Iowa City, IA 52242

1-319-384-5000

Option – 2 (adult)

Option – 1 (trauma) or Option 2 (ED to ED) 

 

Mayo Clinic

200 First Street, Rochester, MN 55905

1-507-255-2910 

 

Denver Health Medical Center

777 Bannock Street, Denver, CO 80204

1-303-602-5000

Hand Trauma Center Network | About Us | ASSH

We do recognize that in some trauma scenarios it is life over limb.  Any poly-trauma patient with potential life-threatening injuries will come to or remain at our Level 1 trauma center where all these issues will be addressed.  If a patient is too unstable to be transferred due to other injuries, we will address these life-threatening injuries first.  Furthermore, if an outside hospital has a poly-trauma patient with a potential re-implantation, those patients will be directed to our facility given the amount of travel time to nearest re-implantation center.  In these situation, we do have the ability to call our hand surgeons that do re-implantations when they are not on-call to inquire for urgent consultation.

Penile Re-implantation

 For penile re-implantation, Urology will be consulted for reimplantation or re-creation.  They will reestablish a urethra for urinary drainage.  Time of reimplantation is determined by Urology and if assistance is required by Plastic surgery, they too will be involved.  Both services are available and on-call 24/7.

 

Trauma Patient Admission Criteria

Trauma patients can be complex with multiple injuries requiring various management strategies, interventions, and care. As a result, determining the appropriate level of care for admission can be challenging. The following represents a list of criteria/conditions that may help guide level of care decision making for the trauma patient. 

ICU ADMISSION

SDCC Admission

FLOOR Admission

Trauma Team Activation (TTA) Criteria


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LEVEL 3 trauma team includes:

LEVEL 2 trauma team includes:

LEVEL 1 - Trauma CONSULTATION

These patients do not meet trauma activation criteria, but merit the expertise of trauma surgeon consultation and/or evaluation, i.e. isolated/single system injuries. A trauma service resident or APP will evaluate these patients within 30 minutes of consult being called and disposition of the patient will be determined within 60 minutes. If the patient requires admission, the trauma attending will evaluate these patients within 8 hours of consult regardless of patient location. 

The EM physician or admitted physician will consult the trauma team for any patient requiring admission to the hospital for any traumatic injury that does not meet trauma activation criteria. This will include but is not limited to the following patients:

Patients who bypass the ED as a direct admit who are admitted for any injury meeting trauma criteria, will require a trauma consultation after notification of the admitting physician. 

Trauma Tertiary Survey

A tertiary survey (exam) should be performed on all patients admitted to the trauma service approximately 24 hours following admission/initial evaluation.  

The tertiary survey is a repeat head-to-toe examination of the trauma patient that is designed to identify injuries (usually more minor) that were not identified on the initial evaluation. Ideally the patient should be able to participate in the exam. EXCEPTION--intubated/sedated ICU patients should still receive a tertiary exam ~24 hrs following admission and also AGAIN, when his/her clinical status allows for them to participate in the exam. 

The following is included in a trauma tertiary exam:

How to complete a trauma tertiary survey at UNMC/Nebraska Medicine 

Step 1: perform the tertiary survey

Step 2: document your tertiary survey 

Step 3: complete tertiary survey template FULLY and ACCURATELY 

 

Trauma Quality Indicators

Background:

From the time a trauma patient is picked up by EMS on scene through the patient's initial assessment, hospital course, and discharge, our trauma program is carefully monitoring each patient and collecting data. Data collected includes demographic information, injury information, prehospital and hospital information, past medical history, traumatic injuries, in-hospital events and outcomes. Data is entered into our trauma registry and analyzed regularly through various performance improvement programs to ensure the trauma service is providing high quality care to each patient. 

Much of the data collected for the registry is gathered by trauma registrars doing extensive chart reviews and depends greatly on complete and accurate documentation from our trauma providers. While we should be practicing complete and accurate documentation as part of being a good healthcare provider, it is also essential for our trauma program to able to monitor and analyze the care of our trauma patients to ensure that high quality care is provided and patient outcomes are optimized. 

Pre-Existing Conditions

Several pre-existing conditions are captured in the trauma registry that help us risk stratify patients for observed and expected outcomes. These pre-existing conditions should be documented in the Trauma H&P and/or the Trauma Tertiary Survey as well as added to the patient's problem list in the electronic medical record. 

The pre-existing conditions captured in the trauma registry are as follows:

  1. Advanced directive limiting care
      • the patient has a written request to limit life-sustaining treatment that restricts the scope of care for the patient during this patient care event signed/dated by patient or designee prior to arrival. 
  2. Alcohol use disorder
      • can be actual diagnosis OR factors consistent with the diagnosis based on American Psychiatric Association, DSM 5 present prior to injury. 
      • only report on patients 15 yrs of age or older. 
  3. Anticoagulant therapy
      • administration of medication (including anticoagulants, antiplatelet agents, thrombin inhibitors, thrombolytic agents) that interferes with blood clotting. Exception: chronic aspirin. 
  4. Attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD)
      • a disorder involving inattention, hyperactivity, or impulsivity requiring medication for treatment present prior to injury. 
  5. Bipolar I/II disorder
      • only report on patients 15 yrs of age or older. 
  6. Bleeding disorder 
      • any condition that results in the blood not clotting properly (e.g. hemophilia, von Willenbrand disease, Factor V Leiden)
  7. Cerebral vascular accident (CVA)
      • history prior to injury of stroke/CVA (embolic, ischemic, thrombotic, or hemorrhagic) with persistent residual motor, sensory or cognitive dysfunction (e.g., hemiplegia, hemiparesis, aphasia, sensory deficit, impaired memory). 
  8. Chronic obstructive pulmonary disease (COPD)
      • lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. Includes more familiar terms such as "chronic bronchitis" and "emphysema".
      • only report on patients 15 yrs of age or older. 
  9. Chronic renal failure
      • chronic renal failure prior to injury that requires periodic peritoneal dialysis, hemodialysis, hemofiltration, or hemodiafiltration. 
  10. Cirrhosis
      • replacement of normal liver tissue with non-living scar tissue related to other liver diseases often resulting in hepatic insufficiency/dysfunction and based on diagnostic imaging studies or laparotomy/laparoscopy. May also be referred to as end-stage liver disease. 
  11. Congenital anomalies 
      • documentation of a pre-existing cardiac, pulmonary, body wall, CNS/Spinal, GI, renal, orthopedic, or metabolic anomaly. 
      • only report on patients less than 15 yrs of age
  12. Congestive heart failure (CHF)
      • inability of the heart to pump a sufficient quantity of blood to meet the metabolic needs of the body or can do so only at an increased ventricular filling pressure. 
      • condition must be noted in medical record as CHF, congestive heart failure or pulmonary edema with onset of increasing symptoms within 30 days prior to injury. 
  13. Current smoker
      • includes patients who report smoking cigarettes every day or some days within the last 12 months.
      • excludes patients who smoke cigars, pipes or smokeless tobacco. 
  14. Currently receiving chemotherapy for cancer
      • includes both oral and parenteral treatments 
  15. Dementia
      • includes, but not limited to, Alzheimer's, Lewy body dementia, frontotemporal dementia (Pick's disease), and vascular dementia.
  16. Diabetes mellitus
      • diabetes mellitus that requires exogenous parenteral insulin or an oral hypoglycemic agent. 
  17. Disseminated cancer
      • cancer that has spread to one or more sites in addition to the primary site (i.e. metastatic or Stage IV cancer)
  18. Functionally dependent health status
      • patients whom, prior to injury, and as a result of cognitive or physical limitations relating to a pre-existing medical condition, were partially or completely dependent upon equipment, devices or another person to complete some or all activities of daily living. 
  19. Hypertension
      • history of persistently elevated blood pressure requiring antihypertensive medication.
  20. Major depressive disorder 
      • only report on patients 15 yrs of age and older. 
  21. Myocardial infarction (MI)
      • history of MI in the 6 moths prior to injury
  22. Other mental/personality disorders 
      • a diagnosis of any of the following prior to injury: antisocial personality disorder, avoidant personality disorder, borderline personality disorder, dependent personality disorder, generalized anxiety disorder, histrionic personality disorder, narcissistic personality disorder, obsessive-compulsive disorder, obsessive-compulsive personality disorder, panic disorder, paranoid personality disorder, and schizotypal personality disorder. 
      • only report in patients 15 yrs of age and older
  23. Peripheral arterial disease (PAD)
      • narrowing or blockage of vessels that carry blood from the heart to the legs. It is primarily caused by the buildup of fatty plaque in the arteries, which is called atherosclerosis. PAD can occur in any blood vessel but is most commonly found in the legs vs arms. 
      • only report in patients age 15 yrs of age or older. 
  24. Post-traumatic stress disorder (PTSD)
      • only report on patients 15 yrs of age or older. 
  25. Pregnancy
      • pregnancy confirmed by lab, ultrasound or other diagnostic tool OR diagnosis of pregnancy documented in the patient's medical record prior to arrival at your center. 
  26. Prematurity 
      • babies born before 37 weeks of pregnancy are completed. 
      • only report in patients less than 15 years of age. 
  27. Schizoaffective disorder
      • only repot on patients 15 yrs of age or older
  28. Schizophrenia 
      • only report on patients 15 yr of age or older
  29. Steroid use
      • regular administration of oral or parenteral corticosteroid medications within 30 days prior to injury for a chronic medical condition. 
      • excludes topical, inhaled, or rectally administered corticosteroids
  30. Substance use disorder 
      • diagnosis or symptoms/patient factors consistent with American Psychiatric Association, DSM 5 present prior to injury. 
      • only report on patients 15 yrs of age or older. 

Hospital Events

Events reviewed through our performance improvement program include the following:

  1. Acute Kidney Injury (AKI)
  2. Acute Respiratory Distress Syndrome (ARDS)
  3. Alcohol withdrawal syndrome
  4. Cardiac arrest with CPR
  5. Catheter-associated urinary tract infection (CAUTI)
  6. Central line-associated blood stream infection (CLABSI)
  7. Deep surgical sight infection
  8. Deep vein thrombosis (DVT)
  9. Delirium
  10. Myocardial infarction (MI)
  11. Organ/space surgical site infection
  12. Osteomyelitis 
  13. Pressure ulcer
  14. Pulmonary embolism (PE)
  15. Severe sepsis
  16. Stroke/CVA
  17. Superficial surgical site infection 
  18. Unplanned admission to the ICU
  19. Unplanned intubation
  20. Unplanned visit to the operating room
  21. Ventilator-associated pneumonia (VAP)

If you are caring for a trauma patient that experiences one of the above stated hospital events, please notify our trauma program/performance improvement coordinators at traumapi@nebraskamed.com.