1. Section Editor(s): Braungardt, Theresa MN, RN
  2. Issue Editor

Article Content

An intense commitment to mission, a vision for the future, and a core set of values shaped Harborview Medical Center into the world class trauma center it is today. To grow from its humble beginnings in 1877 as a 6-bed King County welfare hospital to a premiere high-volume trauma institution with regional support and commitment, outstanding research, and excellent outreach on injury prevention took dedicated faculty and employees, pioneering researchers, and visionary leadership.


This issue of Critical Care Nursing Quarterly is a tribute to the emerging best practices and innovations in the care of trauma patients and their families at Harborview Medical Center. Our dedicated nurses, physicians, respiratory therapists, clinical dieticians, pharmacists, educators, social workers, palliative care, and rehabilitation experts share quality improvement practices from the highly technological aspects of pre-hospital care to guiding families through the difficult discussions around continuation or withdrawal of life-sustaining measures.


The clinical setting primarily not only focuses on critical care but also includes pre-hospital care and the role of the emergency department, acute surgical care, and burn care in acute rehabilitation. Critical care topics include strategies for preventing ventilator-associated pneumonia, reducing oral pressure ulcers in mechanically ventilated patients, pain management, blood culturing practices, nursing care of patients with spinal cord injury, and new paradigms in nutrition support. In addition, embedding the concepts of patient- and family-centered care in daily practice to improve the clinical care experience is explored.


Process improvement around team communication must be a key component of effective clinical care in any large academic medical center. In the article by Turner, "Implementation of TeamSTEPPS in the Emergency Department," the use of a systems model for improving communication among providers is described and demonstrates the potential improvements in patient safety while addressing aspects of staff satisfaction and morale that are so critical to this stressful, high-paced work environment.


Taylor and Tesfamarium in the trauma surgical intensive care unit discuss the development of a multidisciplinary case review process that promotes improved communication and best practices, provides staff education, and works toward instituting system changes and policies that improve patient safety. This type of review process provides a forum for rich discussion among disciplines and across work teams that begins to breakdown existing "silos" between specialty practices working in isolation of each other that often become barriers to effective communication.


Communication with families is also a cornerstone of excellent clinical care because they are often the ones to carry the burden of decision making for loved ones. In the article by Gooding and colleagues, they describe what patient- and family-centered care is at Harborview Medical Center and give specific examples of how to include families in daily operations and quality improvement initiatives. In the article by Owens, the role of the Palliative Care Service in the trauma population describes this service's expertise in pain and symptom assessment and management, as well as in negotiating treatment goals, family communication, and the assessment and treatment of emotional and spiritual pain.


Improvements in clinical care comprise the remainder of topics featured in this issue. In the neuroscience intensive care unit, staff nurses Hillier and Everett describe the development of a quality improvement tool to track blood culturing practices and conclude that fever management would not adversely impact infection identification in a defined group of patients with brain injury. Also in the neuroscience intensive care unit, Rozeboom and fellow nurse colleagues use a case study to demonstrate that early rehabilitation of patients with spinal cord injury in the intensive care setting can potentially lead to shorter lengths of stay and improved clinical outcomes.


In the article by Evans and McNamara, "Infection Control for Critically Ill Trauma Patients: A Systematic Approach to Prevention, Detection, and Provider Feedback," a multidisciplinary approach to decreasing ventilator-associated pneumonia demonstrated a 63% reduction in ventilator-associated pneumonia at the medical center over the past 4 years. In the article by Zaratkiewicz and colleagues, the authors demonstrate that the implementation of an alternative device for securing endotracheal tubes in conjunction with a bite block significantly decreased the reported incidence of hospital-acquired pressure ulcers on the lips, mouth, gums, and tongue. Bailey and colleagues discuss new paradigms in nutrition support. The use of antioxidants, addition of the amino acid glutamine to nutrition therapy, the use of immune-enhancing enteral formulas, and the potential role of probiotics are showing promise in improving patient outcomes in trauma patients. In the article by Martin and colleagues, a group of nurse leaders improved the pain management of trauma surgical patients on the acute care unit and now exceed the top performers in hospital satisfaction scores.


Threaded throughout these articles are stories of innovations in clinical care and process improvement that arose from clinical inquiry and a staff dedicated to the mission, vision, and core values of an institution with a proven track record of healing and saving lives.


-Theresa Braungardt, MN, RN


Issue Editor


Nurse Manager


Neuroscience Intensive Care Unit


Harborview Medical Center


Clinical Instructor


Nursing Program


University of Washington