Authors (including presenting author) :
Yeung JHH (1), Tang N (2), Wong KT (3), James YW Lau (4), Chi Hung Cheng (1) Annie Cheng (3), Wanda Lee (5), NK Cheung (1)
Affiliation :
(1)Department of Accident and Emergency (A&E), Prince of Wales Hospital (PWH); (2) Department of Orthopaedics & Traumatology, PWH; (3) Department of Imaging and Intervention Radiology (DIIR), PWH; (4) Department of Surgery, PWH; (5) Department of Anaesthesia & Intensive Care, PWH
Introduction :
Major trauma patients with life threating unstable pelvic fracture and active bleeding might require pelvic external fixator, laparotomy, vascular embolization and retroperitoneal packing in a timing manner. Traditionally, pelvic embolization is done in DIIR. However, transferring this group of critically ill and continuously bleeding unstable patients from Operation theater (OT) to DIIR in the different floor is not easy which required many man power and patient may not tolerate the transfer.
Objectives :
To minimize unnecessary movement, shorten the procedure time and enhance the patients survive, “Pelvic Embolization Call” system has been set up and the embolization can be done in Hybrid Theater in Non-Office hours. It requires huge supports and collaborations from medical and nursing team in A&E, Orthopedic, OT and DIIR.
Methodology :
The work flow for medical and nursing team in multi-departments are established. A&E firstly identifies and recognizes the patient in need, checks the available of hybrid theater and activates “Pelvic Embolization Call” through operator. A group call was sent to OT in-charge nurse, anesthetist, DIIR radiographer & radiologist. Once receive the call, OT anesthetist and nurses will prepare the Hybird theatre and get the “Polytrauma Set” ready. Radiographer immediately proceeds to prepare the machine, informs and communicates with IR Team radiologist. Radiologist will then get ready in OT. DIIR nurses prepares “Pelvic Embolization Consumable Package” for angiogram and embolization.
Result & Outcome :
From 1/3/2018-28/2/2019, there are total 7 trauma patients required pelvic embolization. 85% (6/7) cases activated pelvic embolization call. The average arrival time of DIIR nurse was 31.1 min; range form 15-49 min. The overall survive rate was 85% as one case died before embolization. There were 3 unexpected survivors and their expected probability of survival by TRISS was 49%, 21% & 23%. Conclusion: The new work flow of Pelvic Embolization Call enhanced the survival rate of trauma patient who required pelvic embolization.
