Awards and Recognition
The greatest reward that Mission Hospital has, is seeing our patients living
full, happy, active lives. But it is also nice to have outside recognition.
Here are just a few ways the Mission Neuroscience Institute has been recognized.
“Improving Outcomes in Severe Traumatic Brain Injury”
Mission Hospital’s trauma team strives to provide care based on best
practice. The clinical outcomes of patients sustaining severe traumatic
brain injury (TBI) were marginal at best, 43% expiring and 30% suffering
severe disability. Research in the past decade has utilized new technology
for monitoring the effects of secondary brain injury and examined the
effects of various treatment modalities on the outcomes of TBI patients.
In 1995, evidenced based clinical guidelines for managing severe TBI were
published recommending changes in care. The guidelines challenged hospitals
to evaluate their care practices and examine the clinical outcomes of
this high-risk group.
Motivated by the new practice recommendations and potential for greatly
impacting patient outcomes, the multidisciplinary trauma team convened
in 1997 to begin the process of performance improvement. Current practice
was examined and new hospital based clinical guidelines developed. Numerous
changes were recommended as the team dismantled current practice patterns
and constructed new care priorities. Every aspect of caring for the severe
TBI patient from admission to rehabilitation was examined. The result
was a series of algorithms with established outcomes at every phase of
the patient’s hospital course.
Three years after integrating the changes into practice, outcomes for the
severe TBI population showed 70% of the patients achieved a good outcome
to moderate disability, 15% sustained severe disability to persistent
vegetative state, and 15% died. These outcomes confirmed that the changes
in practice and intense cooperation resulted in a difference to patients.
Using a performance improvement approach, the quality of care provided
to the TBI population has been significantly enhanced.
The Adam Williams Traumatic Brain Injury Initiative
The Adam Williams Traumatic Brain Injury Initiative was created by Mary
Kay Bader RN, MSN, CCNS (Neuro/Critical Care Clinical Nurse Specialist
(CNS)) in collaboration with philanthropist Nancy Williams. Nancy’s
son, Adam Williams, had sustained a severe traumatic brain injury (TBI)
in 1999. Following his recovery and graduation from school, Nancy sought
ways to improve the outcomes of brain injury patients in the Mission Hospital
community. Following a meeting with Nancy in which she asked how she could
help advance the care of severe TBI patients across the country, Mary
Kay suggested the concept of creating an initiative where funding would
be provided to train hospital staff and fund the purchasing of multimodality
brain monitoring. Nancy’s initial donation of $750,000 was the foundation
for beginning the initiative.
A committee of hospital staff (see participants below), physicians, and
community members developed an application process for outside level I
and II trauma centers. Information on the AWTBI is available on the internet (http://www.awtbii.org/). The website is easy to navigate and provides the application for centers
to complete. The fund provides for three members of the chosen trauma
center to fly to Mission Hospital and spend three to four days with the
surgical intensive care unit (SICU) and trauma team. While at Mission
Hospital, the visiting nurses/physicians receive a four hour lecture by
Mary Kay. They spend two days at the bedside with Mission Hospital’s
nurses learning how to critically manage the severe brain injured patient.
All expenses are paid by the AWTBI fund. In addition, the team receives
three copies of all of Mission Hospital’s protocols, twenty-five
articles from the literature and the BTF Guidelines book. After the Mission
Hospital visit, Mary Kay along with the Nurse Manager/Clinical Director
of SICU, and neurosurgeon Sylvain Palmer MD, travel to the site to provide
a three hour lecture to the physician/leadership team and a four hour
lecture to the nurses/therapists and staff from the chosen site. All expenses
are paid for by the AWTBI fund. The fund provides $50,000 in capital equipment
including two brain oxygen monitors, one cooling machine and one pupillometer.
In addition, the fund provides $5000 to the BTF for the center to enter
data for two years into the BTF database. The initial training of the
centers has been scheduled for five centers per year.
- Mary Kay Bader RN, MSN, CCNS, CCRN, CNRN, FAHA
- Connie Gagliardo, RN, MSN, Executive Director Critical Care and Trauma Services
- Margie Whittaker, RN, MSN, Nurse Manager Surgical Intensive Care Unit
- Surgical ICU Staff all participate to serve to mentors during two-three
Since the launching in 2004, the Mission Hospital team has visited twenty-nine
trauma centers in the United States. From 2009-2011, the team visited
the following hospitals:
- Northwestern Memorial Hospital, Illinois
- Spartanburg Regional Medical Healthcare System, South Carolina
- Morristown Memorial Hospital, New Jersey
- Alaska Native Medical Center, Alaska
- University of California Davis Medical Center, California
- St. Lukes Hospital, Kansas
- Boston University Medical Center, Massachusetts
- Sinai Hospital of Baltimore, Maryland
The training does not end with the Mission Hospital team’s visit.
Consultation occurs on a regular basis. Mary Kay conducts a follow-up
visit one to two years after each center is launched. She conducts interviews
with nurses and physicians to determine the impact of the initiative.
An outcome report is sent back to the AWTBI team on the status of each center.
An excellent example on how our internal expert and external consultant
positively impacted patient outcomes is represented in the 2010 outcome
data from Sanford Hospital in Sioux Falls, South Dakota. Prior to the
AWTBI intervention, Sanford Hospital had only 28% of TBI patients with
an outcome of “good recovery.” This is compared to 63% classified
as having a “good recovery” following AWTBI (see graph EP
7 Figure 9 and attachment sanfordhospitaltbidata.ppt).
By providing a comprehensive package to outside trauma centers, the AWTBI
has impact patient outcomes (see attachment TBI newspaperarticle.doc).
The relationship that is produced from the site visits builds strong connections.
Nurses from the AWTBI hospitals call Mary Kay and Mission Hospital’s
Surgical Intensive Care Unit, asking questions regarding patients the
center is managing at the time of the call. Guidance is provided to the
team. Mary Kay receives email from the site’s personnel and consults
with them on specific issues (see attachment example of emails.doc). The
ability of these centers to access Mary Kay as an external consultant
enables them to have complex questions and clinical situations resolved
by an expert. This support is integral to help other centers overcome
certain barriers in systems and teams.
The utilization of internal and external experts brings advanced knowledge
and clinical wisdom to nurses at the bedside. Supporting practitioners
enhances care practice and improves patient care outcomes.