About a year ago, I became the trauma program manager at Cheyenne Regional Medical Center, a Level II trauma center in Cheyenne, Wyoming. When I accepted the job, many family members and friends and even some colleagues began to ask, “What exactly does a trauma program manager do?” I still struggle to answer that question because the job varies so much from one day to another. But I find it a little easier to describe how I got into this role. The answer is that I tend to go with my gut.
I joined the military back in 2005. I knew from the start that I wanted to be in medicine, so the recruiter asked me, “Do you want to be a ground medic or a flight medic?” I replied, “Flight medic sounds cool.” Only later did I learn what a fascinating field I had stumbled into.
Eleven years later when the opportunity came up to become a trauma program manager, I had the same novice response. “Trauma as a job! That sounds cool.” I quickly realized how vast the world of trauma is and how unique a specialty I had entered.
About six months into my job, I had the opportunity to attend the Trauma Program Manager Course presented by the American Trauma Society. As the attendees introduced themselves, we found that we were an exceptionally diverse group. Some TPMs were from small Level IV facilities and some were from large Level I and II trauma centers. Some represented urban facilities and others came from rural hospitals. There was also a mix of adult and pediatric facilities.
But the interesting thing is that as we got down to work, it became apparent that we were all having the same issues in our trauma programs. We talked about how difficult it is to obtain and organize physician CMEs. How so many of us struggle with developing a robust process improvement program. How hard it is to secure investment in the trauma program.
I thought, “How could I be having the same issues in Wyoming as they are facing in an inner city Level I pediatric trauma center?” That continues to be somewhat of a mystery to me. Clearly, however, the things that make trauma programs the same are a lot more important than the things that make us different.
The important point is that we can all learn from each other. So in that spirit, I would like to share a few of the most useful things I learned during my first year as a TPM.
1. Don’t re-invent the wheel
One of the hardest parts of being a TPM is that you must be able to create a plan of action without definitive guidance. The key is to understand that resources and expertise are available, they are just spread out in various areas. The TPM’s job is to put the pieces together.
Don’t be reluctant to reach out for help to other trauma programs in your state or region and even nationwide. When I began as a TPM, I shamelessly leaned on the established Level I trauma centers in our region. These trauma programs shared their audit filters, tracking tools, legal contracts, activation criteria and other resources. We were able to take these resources and adapt them to our own situation.
Remember that the Orange Book expects Level I trauma centers to act as a mentor to lower-level centers in the region. Use this to your advantage, because one day someone will need to lean on you!
In addition, take full advantage of your state’s resources for trauma programs, including established policies and guidelines. And lastly, reach out to our national trauma organizations. Remember, the trauma community is relatively small and very willing to help.
2. Don’t get stuck on staffing
I have not met one person yet in the trauma world who said, “If I only had a few less people on my staff, we could get so much more done.” I have spent a considerable amount of time calculating how many staff members we need to run an effective program, but the fact is that TPMs need to know how to make do with what they have.
One solution is to look at staff efficiency. For example, examine trauma registry processes. I am lucky to say that all our trauma registrars are registered nurses. I believe their medical background has helped tremendously. Still, as with nearly any team, we found opportunities to streamline their workflows.
One issue was that our registrars were handwriting patient logs and then transferring those logs into our trauma registry. We saw that this was an inefficient process and began to implement a concurrent registry. Now, our registrars immediately enter a set of basic data points into the registry and then complete the full registry entry at a later time. Re-thinking the way we did things was a challenge, but once we started to see the benefits of the new process everyone was more receptive to the change.
Another solution is to think creatively about staff expertise. Currently, our program does not have a staff member who works exclusively on injury prevention. It would be incredible to have a credentialed and experienced employee for this area. However, the resources are just not there. The solution? Look inside your current trauma team. Some trauma programs have built exceptional injury prevention programs by promoting a team member who is energetic, imaginative, willing to learn and able to speak to the community.
3. Come together
To solve the problems we face in the trauma community, we need to come together in a structured way and implement positive change.
In our part of Wyoming, all the TPMs in our region sit down with each other once a quarter. We discuss system issues, case studies, process improvement, pre-hospital involvement and anything else that could benefit the region. What we have discovered is that we can resolve many issues simply by speaking with one another and understanding why these issues exist.
For example, we discovered that some pre-hospital systems did not have the autonomy to activate the helicopter from the field. Their protocol was to first transport injured patients to the small community access hospital. As a group, regional trauma leaders overwhelmingly agreed that all EMS systems must be able to activate air medical support from the field. This decision has helped many patients who sustain critical injuries in remote areas.
4. Step back
When I find myself caught up in the daily grind, I have to remember to take a step back and remember why we do what we do. For me, the best way to do that is to go to the bedside and remember there is an actual patient behind the electronic medical record.
I recently had the opportunity to walk with a trauma patient through their entire care journey. I saw the patient when he entered the emergency department and rounded on him in the ICU. Later, I followed him through the orthopedic inpatient unit and rehab. Ultimately, I was very proud to help that patient walk out of rehab and assist him into his vehicle so he could return home.
The perspective I have gained from physically rounding on patients has proven to be invaluable. While it is difficult to pull myself out of the office, the interactions I have — not only with patients but also with staff — are an excellent opportunity for education. These interactions help me understand how to do my job better.
5. It starts with someone who needs help
I tell people that injury starts with someone who needs the help of others. From that starting point, we have pre-hospital systems, emergency departments, ORs, ICUs, inpatient floors, rehab and ultimately injury prevention. All these resources are focused on the goal of reintegrating the injured person back into society and preventing similar injury in the future.
That goal is what brings us in the trauma world together. Our trauma programs are so diverse, but we are all trying to accomplish the same mission.