There are times when a trauma patient is brought to hospital but not admitted to ICU or other surgical specialties. For over 20 years the Victoria General Hospital has been mandated to design and run a proper trauma MRP (Most Responsible Physician) service, but so far nothing has transpired. In the absence of a dedicated service at VGH, care of trauma patients has defaulted to the hospitalists. But this group of GPs who specialize in complex inpatient medicine have no formal training in trauma care, putting both the patients and the hospitalist physicians at risk. Hospitalists Drs. Matthew Moher and Viv Ming, and their Medical Lead Dr. Chloe Lemire-Elmore recognized that the status quo is unsafe, and decide to look into ways of mitigating the risk.
To begin, they surveyed their hospitalist colleagues to determine their general comfort and qualifications in caring for moderate to high-risk trauma patients. This was followed by a series of lunchtime events where hospitalists first attended live presentations, and then viewed the video screenings by various specialties discussing management of different trauma patients. General Surgeon Dr. Alex Mihailovic presented on management of trauma patients with a focus on the tertiary survey, Dr. James Stone spoke about pelvic fractures, and Dr. John Samphire gave a presentation on management of rib fractures.
These sessions prompted discussions among the hospitalists regarding their preferred scope of care. It became clear that there was significant diversity among hospitalists’ comfort and experience in treating trauma patients, and thus, that an overarching collaborative interdepartmental plan to manage intake and care of this cohort of patients was needed.
The group initiated discussions with General Surgery and came to a new agreement. Calling it a “Bridging MRP” policy, the agreement is that General Surgery (who study major trauma as part of their training) will accept initial care as MRP for at least the first 48 hours of admission for high-risk trauma patients. Hospitalists will remain available for early consult to manage other medical issues, and after 48 hours if the patient is stable, the General Surgeons can ask the hospitalists for an MRP transfer of care.
Next steps include a final presentation from Dr. Richard Reid to review non-operative management of traumatic brain bleeds. The group plans to continue these lunchtime events to boost skills and confidence. They also hope that the new agreement will enhance collaboration with General Surgery, facilitate flow through the Emergency room and lead to improved trauma patient care.