Trauma Program Process Improvement Coordinator

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This Trauma Process Improvement (PI) Coordinator - RN will represent the St.?Charles Bend Trauma Program and will build and strengthen relationships with state and regional agencies and medical facilities involved in the care of the trauma patient. Evaluates the care of the trauma patient via chart and data review and acts as liaison between Trauma Services and other departments within the SCHS such as ED, ICU, OR, and Pediatrics. Provides bidirectional communication, as well as loop closure on clinical, communication, or relationship issues by attending department, agency, and facility meetings and addressing specific problems as they are identified.

Responsible for co?implementing the St.?Charles? Bend Trauma PI Plan, along with the Trauma Program Manager and Trauma Coordinator, following up on PI issues and documenting all loop closure in the Oregon Trauma Registry (OTR). The PI nurse will serve as a program liaison to the Trauma Registry staff and be responsible for writing and interpreting registry and quality reports, identifying trends and developing solutions to address problems with the quality of trauma patient care.

Serves as the primary contact for the St.?Charles? Bend Trauma Registry when interacting with customers. Responsible for clinical data registry activities including case finding, abstracting and coding of clinical data in accordance with State, Federal, The Joint Commission (TJC), American College of Surgeons (ACS) and other Registry guidelines & requirements. Responsible for preparing and submitting hospital and patient data to the State and National Trauma Registries.

This position does not directly manage other caregivers, however, may be asked to review and provide feedback on the work of other caregivers.

Essential Functions And Duties

• Serves as Trauma Program representative and primary contact for the Trauma Registry.
• Performs chart review, participates in and evaluates trauma team performance, M&Ms case review, system and regional loop closure.
• Works collaboratively with other departments to ensure proper event assessment, process improvement, and loop closure, and documents and evaluates the process.
• Establishes systems working with clinical departments, as well as referring facilities to retrieve and review clinical data for abstraction.
• Coordinates, obtains and verifies clinical information and data to support clinical quality performance measurement and improvement.
• Compiles, collates and distributes accurate, complete, and easily interpreted monthly, quarterly and yearly reports.
• Exports clinical data for state, federal or other regulatory and accreditation programs. This includes but is not limited to : trauma data to the Oregon State Trauma Registry (as required by Oregon Law), and the National Trauma Data Bank.
• Analyzes Oregon Health Authority (OHA) and American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) benchmark data and collaborates to identify specific clinical opportunities for improvement.
• Collaborates with internal and external resources to perform QA, loop closure, and clinical education.
• Integrates with hospital quality department by sharing data, participating in quality initiatives and ensures opportunities for confidential nursing case reviews.
• Participates and is a member of relevant boards and committees which may include : Area Trauma Advisory Board (ATAB) / Regional EMS Advisory Board (REMSAB), OHA EMS Advisory Board (EMSAB), Regional Health Preparedness (RHPP), ED, Trauma & Critical Care Committee, Trauma Management Committee, East Cascades EMS (ECEMS) Council, ED Provider and Staff Meetings.
• Assists with coordination of program?related activities, meetings and conferences as necessary for accreditation, performance improvement and service line support.
• Co?coordinates activities in preparation for both Oregon Health Authority and American College of Surgeons site visits to maintain Level?II State of Oregon trauma designation and Level?II ACS trauma verification.
• Maintains a knowledge base regarding changes in abstracting and accreditation standards as it pertains to the Trauma Registry.
• Attends relevant conferences and participates in continuing education opportunities that ensure the maintenance of a knowledge base that contributes to up?to?date, evidence?based standards of care, protocols and clinical practices.
• Understands the Trauma Registrys role in the overall hospital structure as it pertains to accreditations such as The American College of Surgeons and the State of Oregon.
• Participates in creating intentional relationships and demonstrates focus attitudes and behaviors that enhance the care experience.
• Maintains high visibility in the hospital, providing staff opportunities to interact with trauma during staff regular hours.
• Develops cultural competence and provides appropriate care for patients and family members who belong to diverse cultural backgrounds.
• Supports the vision, mission and values of the organization in all respects.
• Supports Value Improvement Practice (VIP?Lean) principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.
• Provides and maintains a safe environment for caregivers, patients and guests.
• Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies and procedures, supporting the organizations corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violations of applicable rules, and cooperating fully with all organizational investigations and proceedings.
• Delivers customer service and / or patient care in a manner that promotes goodwill, is timely, efficient and accurate.
• May perform additional duties of similar complexity within the organization, as required or assigned.

Education

Preferred

Licensure / Certification / Registration

Experience

Senior Level

Mid?Senior level

Employment type

Full?time

Job function

Management and Manufacturing

Industries

Hospitals and Health Care

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