Meet Michigan Medicine: Trauma Burn team strives to be the best thing that happens on a patient’s worst day
The Trauma Burn team at U-M Health provides care for traumatically injured and burned patients, and for critically ill patients in need of surgical intervention. The Trauma Burn ICU, located in University Hospital, houses mostly adult patients and some pediatric burn patients.
The team on the unit works around the clock to care for severely injured patients whose lives have changed suddenly and unexpectedly. Recovery for these patients and their families is often a long journey.
“None of our patients are planning on having a traumatic injury or burn, or needing an ICU stay,” said Jill Cherry-Bukowiec, M.D., M.S., P.N.S., FACS, FCCM, associate professor of general surgery and co-medical director of the Trauma Burn Unit. “We try to be exceptional not only in our medical care but also in our empathy for the patients and their families.”
While the unit serves as the hub for acute trauma and burn care, the work and membership of the Trauma Burn team extends well beyond the 16-bed unit.
A broad multidisciplinary team
The Trauma Burn ICU has a dedicated and passionate team with members who have worked there for decades. But ask anyone to define the team and you will likely hear the same thing: While there are core team members and job functions within the Trauma Burn unit, the team that provides care for these patients encompasses departments and units across the entire health system.
“In reality, our team numbers in the hundreds of people and touches nearly every aspect of U-M Health,” said Mark Hemmila, M.D., professor of surgery in the Division of Acute Care Surgery. “Outside of the core trauma team, key members include faculty and staff in the ED, OR and ICUs. We work closely with the Emergency Department, orthopaedic surgery, neurosurgery and anesthesiology, and receive support from many ancillary services including the Blood Bank, radiology, physical and occupational therapy, social work and pharmacy, among others.”
The Trauma Burn unit at U-M Health was one of the first ICUs in the state to have a multidisciplinary team over 50 years ago, according to Jill Cherry-Bukowiec, M.D., M.S., P.N.S., FACS, FCCM, associate professor of general surgery and co-medical director of the Trauma Burn unit.
“Most ICUs and critical care locations now use this type of model to give the best care we can to patients in a holistic way,” she said.
Lori Pelham, M.S.N., R.N., clinical nursing director for the Trauma Burn Unit said being a multidisciplinary team is important, especially for burn patients.
“You have to take care of the mind, body and soul with these patients,” she explained. “When they arrive in our unit, it’s a devastating injury and it changes their lives forever.
“The nurses do the wound care, the doctors do the surgery on the wounds, the dietitian makes sure we’re giving them enough nutrition because they require so many calories in order for their wounds to heal. Social work is there for the family and the patient. Pharmacy makes sure we have the right drugs.”
“We all tend to sing each other’s praises,” said Stewart Wang, M.D., Ph.D., FACS, co-medical director of the unit. “This is especially important for transition of care. The first time I walk in to see patients, nurses have already told them about me. This helps patients understand the roles of everyone on the team.”
“Our students, residents and trainees really learn from this multidisciplinary approach to patient care and critical care,” said Cherry-Bukowiec.
Safety and quality
The Trauma Burn team recently achieved reverification as a Level One Trauma Center from the American College of Surgeons, and as an American Burn Association-verified Burn Center. Both verifications are the result of collaborative, painstaking efforts and unfailing commitment to quality and safety. And both speak volumes about the level of care provided.
“The trauma and burn programs both incorporate a rigorous performance improvement and patient safety process,” said Cindy Wegryn, Trauma Burn program manager. “Complications and patient events are carefully reviewed and often lead to protocol or policy change, resource allocation or staff education to help assure optimal care for patients.”
The trauma and burn verifications both occur in a three-year cycle and involve months of preparation followed by on-site visits.
“The verification as a level one center, which is the highest level of verification a trauma center can achieve, demonstrates to the community and the patients we serve that we’re able to provide all the specialty care trauma patients require 24/7, 365,” said Chris Wagner, Trauma Burn program manager. “It’s an expensive and complex system and not many hospitals are able to achieve that designation.
“The other focus of level one is research so, in addition to the clinical enterprise, we have to be able to demonstrate a research component, which is also a foundation of the mission here at Michigan Medicine,” Wagner said.
Naveen Sangji, M.D., M.P.H., FACS, assistant professor in the Division of Acute Care Surgery, said that being a verified burn center requires a very engaged team for all aspects of patient care.
“Reverification is a massive team effort,” she said. “Countless people from all over the hospital were involved and every single team member is extremely important to this process.”
Another aspect to burn reverification is a commitment to community education and prevention.
“We take our responsibility to the community very seriously,” said Sangji. “We have a community outreach and injury prevention program. We do education all over the state, and our leadership is intimately involved with the State of Michigan Burn Coordinating Center.”
In 2021, the Trauma Burn unit earned a prestigious Silver Beacon Award from the American Association of Critical Care Nurses (AACN). A Beacon Award is earned through demonstrated performance in a number of different areas including leadership, staff engagement, communication, learning and development and evidence-based practice. It represents exceptional care through improved patient outcomes and satisfaction, and a positive and supportive work environment, with greater collaboration between colleagues and leaders, higher morale and lower turnover.
The Trauma Burn unit is being recognized with a 2022 Nursing at Michigan Excellence Award later this month.
Finally, the unit launched its own awards program several years ago. All staff and faculty are invited to nominate their teammates for awards in seven different categories, and each award goes to the team member receiving the most votes from their peers.
Passion, patience and appreciation
On the Trauma Burn unit, passion, patience and appreciation help keep the team going – and staying. The MPLAN leaders have all been on the unit for a while now, Wang for 27 years, Pelham and Cherry-Bukowiec for 14. The demanding work on the unit is supported by a family culture where team members understand the importance of recognizing and holding each other up.
“Our wound care nurses in particular deserve a lot of credit,” said Wang. “Their work involves very uncomfortable, hard labor. They dress in plastic and work in hot temperatures. They are the best at what they do, and they share their expertise by teaching staff on other units how to care for wounds.”
“I have nurses and techs who’ve been on the unit for many years,” said Pelham, “and I think their passion comes from seeing the gains these patients make. It doesn’t happen in a day; it doesn’t even happen in a week. It happens sometimes over months.”
Pelham said being able to talk to patients and families and give them hope is an important part of the work her team does every day.
“We have a great team, and I’m so proud of the work they do,” said Pelham. “They give it their all. When they come to work, they are here to take care of the patients and the families. But I think the biggest thing is to see them support each other.”
Worst injuries, best outcomes
“Many of our patients are complex and complicated,” said Wagner. “Despite that, we have some of the lowest mortality in the state and in the country for these very badly injured people.”
Hemmila said he is proud of the extraordinary efforts of the Trauma Burn team.
“These patients are often having the worst day of their life,” he said. “We can make it better.”
“We have lots of positive outcomes where we send patients back to their families and to their communities, healthy and intact,” Wagner said. “It really is a rewarding specialty to be in because of the good work all these people do.”
To learn even more about Trauma Burn, check out the latest Adult Hospitals Short Takes video below!