2001 OPEN FORUM Abstracts
USE OF ABG IN TRAUMAFOR EARLY RECOGNITION OF ACIDOSIS AND HYPOXEMIA
Kathy Cadden, RN;Elizabeth Norman, B.S. RRT, RCP; and Julie Booth, MS, CPHQ. ProvidenceHoly Cross Medical Center, Mission Hills, Ca.
Background: The ICU TraumaTeam had a concern with timeliness of interventions for acidosis and hypoxemia.After a review of the literature and data information from other trauma centers,it was determined that no guideline existed for the early recognition and treatmentof acidosis and hypoxemia. To establish baseline data, an initial chart review(cases from Apr 1998 - Apr 1999) was completed after establishing what requireddata elements were needed for the database. Initial chart review analysis revealedthat it took approximately 13.8 hours from arrival to the emergency room toidentification of acidosis or hypoxemia. The resolution rate for acidosis was65% and 58.3% for hypoxemia within initial 24 hrs of arrival.
Method: In order to identifyeither of these conditions earlier and therefore, be able to treat earlier,a 2 month pilot project was implemented. The pilot project called for an ABGbe obtained in the ED if the patient was to be admitted to ICU unless 1.) contraindicatedby MD, or 2.) the patient was going from the ED to Surgery. Respiratory Therapywas to draw ABG based on set criteria.
Results: 89% of the Traumapatients in the pilot project had acidosis/hypoxemia on 1st ABG drawn. The timefrom identification to resolution of acidosis was decreased by 29.4%. (p <.05) The time from identification to resolution of hypoxemia was decreased by35.6%. (p < .05) The resolution rate of Hypoxemia/Acidosis within initial24 hrs of arrival = 93.75%. A significant implication of this improvement resultedin an actual charge savings of $1850 which is the ICU Trauma bed rate minusABG charge.
Conclusion: These resultswere presented to Medical Staff and a procedure was approved for RespiratoryTherapy to routinely perform an ABG on all Trauma patients in the emergencyroom who would be admitted directly to the ICU.