The Development of a Fast Track of Care for Multiple Injury in Suratthani Hospital

Abstract

Background: Patient with multiple injuries suffers complicated health problems which require appropriate care from the beginning to prevent complications and increased survival rate.  According to the hospital records, the number of patients with severe multiple injuries admitted in Emergency Department increased from 10.5% to 14.94% from the fiscal year 2561 B.E. to 2563 B.E., respectively. In the same period, the mortality rate in Emergency Department increased from 1.19% to 1.57%. These data trends caught researcher’s interest to develop a nursing practice guideline on a fast-track of care for severe multiple injury patient admitting in Emergency Department.

Objective: To develop nursing practice guideline on a fast-track of care to evaluate the efficacy of care according to Advanced Trauma Life Support (ATLS) guidelines for patient with multiple injuries admitting emergency department of Suratthani hospital. 

Method: This research and development study adopted Deming Cycle of quality: PDCA as a conceptual framework. The analysis of data was carried out by employing descriptive statistics, i.e., frequency, percentage, average; and analytic statistics, i.e., Paired T-test, Independent T-test, chi-square.

Results: According to the results, the developed nursing practice guideline base on Advanced Trauma Life Support (ATLS) guidelines could be benefit a good outcome, the samples of 40 registered nurses who were trained to develop caring skill according to the guideline possessed statistically significant increase of knowledge score comparing pre- and post-training test (p<.001). There were 100% of patients with multiple injuries received the fast-track care according to the fast-track care guideline. Meanwhile, the mortality rate during guideline intervention were significant different with those of the pre-intervention period (p = .006).

Conclusions: After the intervention of fast track caring nursing practice guideline for patients with multiple injuries according to ATLS evaluation protocol, samples who were registered nurses possessed higher knowledge score and caring practice score than those of before the intervention. In addition, the patient with severe multiple injuries’ satisfaction score toward the caring after the intervention were averagely higher than those before the intervention.