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Koko JAB, Mohamed OSA, Koko BAB, Musa OAY. The ABCDE approach: Evaluation of adherence in a low-income country. Injury 2024; 55:111268. [PMID: 38097486 DOI: 10.1016/j.injury.2023.111268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/23/2023] [Accepted: 12/01/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND Early recognition and initial treatment of trauma patients prevents deterioration and buys time for making a definitive diagnosis. The "Airway, Breathing, Circulation, Disability and Exposure" (ABCDE) approach should be used whenever an injury is suspected. It provides quick identification and management of life-threatening problems. Still, there is limited knowledge regarding adherence to the ABCDE approach. This research aims to assess the adherence of the trauma team members to the ABCDE approach in the management of major trauma patients and the factors affecting it. METHOD The study is a cross-sectional hospital-based study conducted in the trauma and resuscitation rooms of major governmental hospitals in Khartoum in the period from Jan.30, 2022, to Mar.29, 2022. It was done among the medical staff dealing with major trauma cases. Data were collected by observation using a modified standardized checklist for assessing the ABCDE approach and via a self-administered questionnaire for identifying the factors affecting adherence. Total coverage of all major trauma cases resuscitation (n = 50) was done. Also, a sample size of 158 medical staff was covered for the questionnaire. The data was analyzed in Statistical Package for the Social Science (SPSS) V.23. RESULTS The mean percentage of adherence to the ABCDE approach was 37.9 % (SD 15.44). When the ABCDE sequence was not followed, the ACB was the commonest sequence. Also, adherence had no significant relation with any patient or staff-related factor. The main present obstacles to adherence to the ABCDE approach were overcrowding in the room and unprepared facilities. While the major present facilitator was the clinical experience. CONCLUSION The adherence rate was low, but initiation of the ABCDE approach was rapid. The factors participating in low adherence rates were usually facility or population-based factors. We recommend further studies, further training and embedment of guidelines, and the provision of larger trauma rooms with adequate supplies.
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Affiliation(s)
- Julia Adam Bashir Koko
- Faculty of Medicine, University of Medical Sciences and Technology (UMST), Khartoum, Sudan.
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2
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Carenzo L, Mercalli C, Reitano E, Tartaglione M, Ceolin M, Cimbanassi S, Del Fabbro D, Sammartano F, Cecconi M, Coniglio C, Chiara O, Gamberini L. State of the art of trauma teams in Italy: A nationwide study. Injury 2024; 55:111388. [PMID: 38316572 DOI: 10.1016/j.injury.2024.111388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
Trauma teams play a vital role in providing prompt and specialized care to trauma patients. This study aims to provide a comprehensive description of the presence and organization of trauma teams in Italy. A nationwide cross-sectional epidemiological study was conducted between July and October 2022, involving interviews with 137 designated trauma centers. Centers were stratified based on level: higher specialized trauma centers (CTS), intermediate level trauma centers (CTZ + N) and district general hospital with trauma capacity (CTZ). A standardized structured interview questionnaire was used to gather information on hospital characteristics, trauma team prevalence, activation pathways, structure, components, leadership, education, and governance. Descriptive statistics were used for analysis. Results showed that 53 % of the centers had a formally defined trauma team, with higher percentages in CTS (73 %) compared to CTZ + N (49 %) and CTZ (39 %). The trauma team activation pathway varied among centers, with pre-alerts predominantly received from emergency medical services. The study also highlighted the lack of formally defined massive transfusion protocols in many centers. The composition of trauma teams typically included airway and procedure doctors, nurses, and healthcare assistants. Trauma team leadership was predetermined in 59 % of the centers, with anesthesiologists/intensive care physicians often assuming this role. The study revealed gaps in trauma team education and governance, with a lack of specific training for trauma team leaders and low utilization of simulation-based training. These findings emphasize the need for improvements in trauma management education, governance, and the formalization of trauma teams. This study provides valuable insights that can guide discussions and interventions aimed at enhancing trauma care at both local and national levels in Italy.
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Affiliation(s)
- Luca Carenzo
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy.
| | - Cesare Mercalli
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Elisa Reitano
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
| | - Marco Tartaglione
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Martina Ceolin
- Department of Trauma and Acute Care Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy
| | - Stefania Cimbanassi
- Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Pathophysiology and Transplants, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Daniele Del Fabbro
- Department of Trauma and Acute Care Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy
| | - Fabrizio Sammartano
- Department of Trauma Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, 20162, Milan, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Osvaldo Chiara
- Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Pathophysiology and Transplants, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
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Okada I, Hifumi T, Yoneyama H, Inoue K, Seki S, Jimbo I, Takada H, Nagasawa K, Kohara S, Hishikawa T, Shiojima H, Hasegawa E, Morimoto K, Ichinose Y, Sato F, Kiriu N, Matsumoto J, Yokobori S. Survival benefits of interventional radiology and surgical teams collaboration during primary trauma surveys: a single-centre retrospective cohort study. BMC Emerg Med 2024; 24:65. [PMID: 38627690 PMCID: PMC11021012 DOI: 10.1186/s12873-024-00977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND A team approach is essential for effective trauma management. Close collaboration between interventional radiologists and surgeons during the initial management of trauma patients is important for prompt and accurate trauma care. This study aimed to determine whether trauma patients benefit from close collaboration between interventional radiology (IR) and surgical teams during the primary trauma survey. METHODS A retrospective observational study was conducted between 2014 and 2021 at a single institution. Patients were assigned to an embolization group (EG), a surgery group (SG), or a combination group (CG) according to their treatment. The primary and secondary outcomes were survival at hospital discharge compared with the probability of survival (Ps) and the time course of treatment. RESULTS The analysis included 197 patients, consisting of 135 men and 62 women, with a median age of 56 [IQR, 38-72] years and an injury severity score of 20 [10-29]. The EG, SG, and CG included 114, 48, and 35 patients, respectively. Differences in organ injury patterns were observed between the three groups. In-hospital survival rates in all three groups were higher than the Ps. In particular, the survival rate in the CG was 15.5% higher than the Ps (95% CI: 7.5-23.6%; p < 0.001). In the CG, the median time for starting the initial procedure was 53 [37-79] min and the procedure times for IR and surgery were 48 [29-72] min and 63 [35-94] min, respectively. Those times were significantly shorter among three groups. CONCLUSION Close collaboration between IR and surgical teams, including the primary survey, improves the survival of severe trauma patients who require both IR procedures and surgeries by improving appropriate treatment selection and reducing the time process.
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Affiliation(s)
- Ichiro Okada
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan.
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan.
| | - Toru Hifumi
- Department of Emergency Medicine, St. Luke's International Hospital, 9-1, Akashicho, Chuo-ku, 104-8560, Tokyo, Japan
| | - Hisashi Yoneyama
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Kazushige Inoue
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Satoshi Seki
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Ippei Jimbo
- Department of Anesthesia, Kyorin University Hospital, 6-20-2 Shinkawa, 181-8611, Mitaka city, Tokyo, Japan
| | - Hiroaki Takada
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Koichi Nagasawa
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Saiko Kohara
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Tsuyoshi Hishikawa
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Hiroki Shiojima
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Eiju Hasegawa
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Kohei Morimoto
- Department of Radiology, Kawasaki Municipal Tama Hospital, 1-30-37 Shukugawara, Tama-ku, 214-8525, Kawasaki city, Japan
| | - Yoshiaki Ichinose
- Department of Radiology, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Fumie Sato
- Department of Radiology, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Nobuaki Kiriu
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2, 359-8513, Namiki, Tokorozawa city, Saitama, Japan
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, 216-8511, Kawasaki city, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan
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Berkeveld E, Azijli K, Bloemers FW, Giannakópoulos GF. The effect of a clock's presence on trauma resuscitation times in a Dutch level-1 trauma center: a pre-post cohort analysis. Eur J Trauma Emerg Surg 2024; 50:489-496. [PMID: 37794254 PMCID: PMC11035447 DOI: 10.1007/s00068-023-02371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Interventions performed within the first hour after trauma increase survival rates. Literature showed that measuring times can optimize the trauma resuscitation process as time awareness potentially reduces acute care time. This study examined the effect of a digital clock placement on trauma resuscitation times in an academic level-1 trauma center. METHODS A prospective observational pre-post cohort analysis was conducted for six months before and after implementing a visible clock in the trauma resuscitation room, indicating the time passed since starting the in-hospital resuscitation process. Trauma patients (age ≥ 16) presented during weekdays between 9.00 AM and 9.00 PM were included. Time until diagnostics (X-Ray, FAST, or CT scan), time until therapeutic intervention, and total resuscitation time were measured manually with a stopwatch by a researcher in the trauma resuscitation room. Patient characteristics and information regarding trauma- and injury type were collected. Times before and after clock implementation were compared. RESULTS In total, 100 patients were included, 50 patients in each cohort. The median total resuscitation time (including CT scan) was 40.3 min (IQR 23.3) in the cohort without a clock compared to 44.3 (IQR 26.1) minutes in the cohort with a clock. The mean time until the first diagnostic and until the CT scan was 8.3 min (SD 3.1) and 25.5 min (SD 7.1) without a clock compared to 8.6 min (SD 6.5) and 26.6 min (SD 11.5) with a clock. Severely injured patients (Injury Severity Score (ISS) ≥ 16) showed a median resuscitation time in the cohort without a clock (n = 9) of 54.6 min (IQR 50.5) compared to 46.0 min (IQR 21.6) in the cohort with a clock (n = 8). CONCLUSION This study found no significant reduction in trauma resuscitation time after clock placement. Nonetheless, the data represent a heterogeneous population, not excluding specific patient categories for whom literature has shown that a short time is essential, such as severely injured patients, might benefit from the presence of a trauma clock. Future research is recommended into resuscitation times of specific patient categories and practices to investigate time awareness.
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Affiliation(s)
- Eva Berkeveld
- Department of Trauma Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Kaoutar Azijli
- Department of Emergency Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Trauma Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Georgios F Giannakópoulos
- Department of Trauma Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Jamshidi Z, Norouzi Tabrizi K, Khankeh H, Zeraati Nasrabadi M, Sadeghi H, Eghbali M. Design and psychometric properties of the acute care quality in trauma emergency units scale. Eur J Trauma Emerg Surg 2024; 50:447-453. [PMID: 37728635 DOI: 10.1007/s00068-023-02360-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/27/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Systematic trauma care scale could be designed and used by nurses to completely and adequately fulfill a complex care to improve trauma care quality. The purpose of this study was to design and evaluate the psychometric property of the Nursing Care Quality in Trauma Emergency Units and trauma care promotion. METHODS This methodological study was conducted in 2022. The process of designing and psychometric assessment of the scale was performed in two steps such as Generating an Item Pool and Validity and Reliability evaluation (Item reduction). The construct validity was determined using the experimental intervention; for determining the reliability of the scale and internal consistency, we measured the inter-rater reliability (IRR). Data were analyzed using the SPSS software, version 22. RESULTS Based on our findings, the CVI and CVR of the scale were 1 and 0.83-1, respectively. A significant difference between the pre- and post-intervention scores in group 1 supports the inference that the construct has been appropriately represented, and the instrument has construct validity (p < 0.001). We found that there was a significant difference in the scores of Patient assessment, Planning and Implementations, and Evaluation of the care plan. The inter-rater reliability method allows the optimal reliability assessment of observational instruments, which was used in this study, and the results confirmed excellent reliability of the instrument. CONCLUSIONS The validity and reliability of the Nursing Care Quality in Trauma Emergency Units Scale were confirmed. The instrument could successfully assess the process of nursing care in the trauma emergency ward. The use of this checklist is recommended as a valid observational tool for other researchers. STUDY TYPE Therapeutic/care management.
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Affiliation(s)
- Zahra Jamshidi
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Kian Norouzi Tabrizi
- School of Behavioral Sciences and Mental Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamidreza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | | | - Hajar Sadeghi
- Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Eghbali
- School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
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Fornander L, Laukkanen K, Molin I, Nilsson L, Berggren P. Team communication patterns during real and simulated trauma resuscitation-a social network analysis. ERGONOMICS 2024; 67:225-239. [PMID: 37273191 DOI: 10.1080/00140139.2023.2221000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
In trauma teams, coordination can be established through a centralised leader. The team can also use a decentralised strategy. In this descriptive study of video-recorded trauma resuscitations, using quantification of qualitative data, Social Network analysis of all real-time communications of eight in-real-life (IRL) and simulated trauma teams explained team social structure. The communication network structures in the simulated scenarios were more centralised using individually directed speech and had a high proportion of communication to update all team members. Such a structure might be the result of work performed in a complexity-stripped simulation environment where simplified task-executions required less interactions, or from work revolving around a deteriorating patient, imposing high demands on rapid decision-making and taskwork. Communication IRL was mostly decentralised, with more variability between cases, possibly due to unpredictability of the IRL case. The flexibility to act in a decentralised manner potentiates adaptability and seems beneficial in rapidly changing situations.Practitioner summary: Efficient collaboration in trauma teams is essential. Communication in in-real-life and simulated trauma teams was analysed using social network analysis. The simulation teams were overall more centralised compared to the IRL teams. The flexibility to act decentralised seems beneficial for emergency teams as it enables adaptability in unpredictable situations.
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Affiliation(s)
- Liselott Fornander
- Department of Anaesthesiology and Intensive Care in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kati Laukkanen
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ida Molin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Emergency Medicine, Norrköping and Centre for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Peter Berggren
- Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
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7
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Green RS. Trauma team leadership in Canada: present and future. CAN J EMERG MED 2023; 25:929-930. [PMID: 38060162 DOI: 10.1007/s43678-023-00618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Affiliation(s)
- Robert S Green
- Departments of Critical Care, Emergency Medicine, Anesthesia and Surgery, Dalhousie University, Halifax, NS, Canada.
- Trauma Nova Scotia, Nova Scotia Health, Halifax, NS, Canada.
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8
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Cameron P. Triage of older trauma patients. CAN J EMERG MED 2023; 25:851-852. [PMID: 37921962 DOI: 10.1007/s43678-023-00581-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Affiliation(s)
- Peter Cameron
- School Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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9
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van Wessem KJP, Leenen LPH, Houwert RM, Benders KEM, Simmermacher RKJ, van Baal MCPM, de Bruin IGJM, de Jong MB, Nijs SJB, Hietbrink F. Outcome of severely injured patients in a unique trauma system with 24/7 double trauma surgeon on-call service. Scand J Trauma Resusc Emerg Med 2023; 31:60. [PMID: 37880795 PMCID: PMC10598943 DOI: 10.1186/s13049-023-01122-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/22/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The presence of in-house attending trauma surgeons has improved efficiency of processes in the treatment of polytrauma patients. However, literature remains equivocal regarding the influence of the presence of in-house attendings on mortality. In our hospital there is a double trauma surgeon on-call system. In this system an in-house trauma surgeon is 24/7 backed up by a second trauma surgeon to assist with urgent surgery or multiple casualties. The aim of this study was to evaluate outcome in severely injured patients in this unique trauma system. METHODS From 2014 to 2021, a prospective population-based cohort consisting of consecutive polytrauma patients aged ≥ 15 years requiring both urgent surgery (≤ 24h) and admission to Intensive Care Unit (ICU) was investigated. Demographics, treatment, outcome parameters and pre- and in-hospital transfer times were analyzed. RESULTS Three hundred thirteen patients with a median age of 44 years (71% male), and median Injury Severity Score (ISS) of 33 were included. Mortality rate was 19% (68% due to traumatic brain injury). All patients stayed ≤ 32 min in ED before transport to either CT or OR. Fifty-one percent of patients who needed damage control surgery (DCS) had a more deranged physiology, needed more blood products, were more quickly in OR with shorter time in OR, than patients with early definitive care (EDC). There was no difference in mortality rate between DCS and EDC patients. Fifty-six percent of patients had surgery during off-hours. There was no difference in outcome between patients who had surgery during daytime and during off-hours. Death could possibly have been prevented in 1 exsanguinating patient (1.7%). CONCLUSION In this cohort of severely injured patients in need of urgent surgery and ICU support it was demonstrated that surgical decision making was swift and accurate with low preventable death rates. 24/7 Physical presence of a dedicated trauma team has likely contributed to these good outcomes.
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Affiliation(s)
- Karlijn J P van Wessem
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - R Marijn Houwert
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Kim E M Benders
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Roger K J Simmermacher
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Mark C P M van Baal
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ivar G J M de Bruin
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Mirjam B de Jong
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Stefaan J B Nijs
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Falco Hietbrink
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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10
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Spering C, Lehmann W, Möller S, Bieler D, Schweigkofler U, Hackenberg L, Sehmisch S, Lefering R. The pelvic vascular injury score (P-VIS): a prehospital instrument to detect significant vascular injury in pelvic fractures. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02374-x. [PMID: 37872264 DOI: 10.1007/s00068-023-02374-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/24/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The purpose of this study was to identify predictive factors for peri-pelvic vascular injury in patients with pelvic fractures and to incorporate these factors into a pelvic vascular injury score (P-VIS) to detect severe bleeding during the prehospital trauma management. METHODS To identify potential predictive factors, data were taken (1) of a Level I Trauma Centre with 467 patients (ISS ≥ 16 and AISPelvis ≥ 3). Analysis including patient's charts and digital recordings, radiographical diagnostics, mechanism and pattern of injury as well as the vascular bleeding source was performed. Statistical analysis was performed descriptively and through inference statistical calculation. To further analyse the predictive factors and finally develop the score, a 10-year time period (2012-2021) of (2) the TraumaRegister DGU® (TR-DGU) was used in a second step. Relevant peri-pelvic bleeding in patients with AISPelvis ≥ 3 (N = 9227) was defined as a combination of the following entities (target group PVITR-DGU N = 2090; 22.7%): pelvic fracture with significant bleeding (> 20% of blood volume), Injury of the iliac or femoral artery or blood transfusion of ≥ 6 units (pRBC) prior to ICU admission. The multivariate analysis revealed nine items that constitute the pelvic vascular injury score (P-VIS). RESULTS In study (1), 467 blunt pelvic trauma patients were included of which 24 (PVI) were presented with significant vascular injury (PVI, N = 24; control (C, N = 443). Patients with pelvic fractures and vascular injury showed a higher ISS, lower haemoglobin at admission and lower blood pressure. Their mortality rate was higher (PVI: 17.4%, C: 10.3%). In the defining and validating process of the score within the TR-DGU, 9227 patients met the inclusion criteria. 2090 patients showed significant peripelvic vascular injury (PVITR-DGU), the remaining 7137 formed the control group (CTR-DGU). Nine predictive parameters for peripelvic vascular injury constituted the peripelvic vascular injury score (P-VIS): age ≥ 70 years, high-energy-trauma, penetrating trauma/open pelvic injury, shock index ≥ 1, cardio-pulmonary-resuscitation (CPR), substitution of > 1 l fluid, intubation, necessity of catecholamine substitution, remaining shock (≤ 90 mmHg) under therapy. The multi-dimensional scoring system leads to an ordinal scaled rating according to the probability of the presence of a vascular injury. A score of ≥ 3 points described the peripelvic vascular injury as probable, a result of ≥ 6 points identified a most likely vascular injury and a score of 9 points identified an apparent peripelvic vascular injury. Reapplying this score to the study population a median score of 5 points (range 3-8) (PVI) and a median score of 2 points (range 0-3) (C) (p < 0.001). The OR for peripelvic vascular injury was 24.3 for the patients who scored > 3 points vs. ≤ 2 points. The TR-DGU data set verified these findings (median of 2 points in CTR-DGU vs. median of 3 points with in PVITR-DGU). CONCLUSION The pelvic vascular injury score (P-VIS) allows an initial risk assessment for the presence of a vascular injury in patients with unstable pelvic injury. Thus, the management of these patients can be positively influenced at a very early stage, prehospital resuscitation performed safely targeted and further resources can be activated in the final treating Trauma Centre.
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Affiliation(s)
- Christopher Spering
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, Goettingen University Medical Center, Universitaetsmedizin Goettingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, Goettingen University Medical Center, Universitaetsmedizin Goettingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Stefanie Möller
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, Goettingen University Medical Center, Universitaetsmedizin Goettingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- Department of Orthopedic Trauma Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Dan Bieler
- Department of Orthopaedics and Trauma Surgery, Heinrich Heine University Medical School, Düsseldorf, Germany
- Department for Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Uwe Schweigkofler
- Department of Orthopedic Trauma Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Lisa Hackenberg
- Department for Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Stephan Sehmisch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, Goettingen University Medical Center, Universitaetsmedizin Goettingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- Department of Trauma Surgery, Hannover Medical School (MHH), Hannover, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
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Montserrat Ortiz N, Trujillano Cabello J, Badia Castelló M, Vilanova Corsellas J, Jimenez Jimenez G, Rubio Ruiz J, Pujol Freire A, Morales Hernandez D, Servia Goixart L. Implementation of a major trauma team. Analysis of activation and care times in patients admitted to the ICU. Med Intensiva 2023; 47:427-436. [PMID: 36470735 DOI: 10.1016/j.medine.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To analyze the factors associated with the activation of the severe trauma care team (STAT) in patients admitted to the ICU, to measure its impact on care times, and to analyze the groups of patients according to activation and level of anatomical involvement. DESIGN Prospective cohort study of severe trauma admitted to the ICU. From June 2017 to May 2019. Risk factors for the activation of the STAT analysed with logistic regression and CART type classification tree. SETTING Second level hospital ICU. PATIENTS Patients admitted consecutively. INTERVENTIONS No. MAIN VARIABLES OF INTEREST STAT activation. Demographic variables. Injury severity (ISS), intentionality, mechanism, assistance times, evolutionary complications, and mortality. RESULTS A total of 188 patients were admitted (46.8% of STAT activation), median age of 52 (37-64) years (activated 47 (27-62) vs not activated 55 (42-67) P = 0.023), males 84.0%. No difference in mortality according to activation. The logistic model finds as factors: care (16.6 (2.1-13.2)) and prehospital intubation (4.2 (1.8-9.8)) and severe lower extremity injury (4.4 (1.6-12.3)). Accidental fall (0.2 (0.1-0.6)) makes activation less likely. The CART model selects the type of trauma mechanism and can separate high and low energy trauma. CONCLUSIONS Factors associated with STAT activation were prehospital care, requiring prior intubation, high-energy mechanisms, and severe lower extremity injuries. Shorter care times if activated without influencing mortality. We must improve activation in older patients with low-energy trauma and without prehospital care.
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Affiliation(s)
- N Montserrat Ortiz
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova de Lleida, Spain; IRBLLeida (Institut de Recerca Biomèdica de Lleida. Fundació Dr. Pifarré), Spain
| | - J Trujillano Cabello
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova de Lleida, Spain; IRBLLeida (Institut de Recerca Biomèdica de Lleida. Fundació Dr. Pifarré), Spain
| | - M Badia Castelló
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova de Lleida, Spain; IRBLLeida (Institut de Recerca Biomèdica de Lleida. Fundació Dr. Pifarré), Spain
| | - J Vilanova Corsellas
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova de Lleida, Spain; IRBLLeida (Institut de Recerca Biomèdica de Lleida. Fundació Dr. Pifarré), Spain
| | - G Jimenez Jimenez
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova de Lleida, Spain; IRBLLeida (Institut de Recerca Biomèdica de Lleida. Fundació Dr. Pifarré), Spain
| | - J Rubio Ruiz
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova de Lleida, Spain; IRBLLeida (Institut de Recerca Biomèdica de Lleida. Fundació Dr. Pifarré), Spain
| | - A Pujol Freire
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova de Lleida, Spain; IRBLLeida (Institut de Recerca Biomèdica de Lleida. Fundació Dr. Pifarré), Spain
| | - D Morales Hernandez
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova de Lleida, Spain; IRBLLeida (Institut de Recerca Biomèdica de Lleida. Fundació Dr. Pifarré), Spain
| | - L Servia Goixart
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova de Lleida, Spain; IRBLLeida (Institut de Recerca Biomèdica de Lleida. Fundació Dr. Pifarré), Spain.
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12
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Bento A, Ferreira L, Yánez Benitez C, Koleda P, Fraga GP, Kozera P, Baptista S, Mesquita C, Alexandrino H. Worldwide snapshot of trauma team structure and training: an international survey. Eur J Trauma Emerg Surg 2023; 49:1771-1781. [PMID: 36414695 DOI: 10.1007/s00068-022-02166-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Trauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained. MATERIALS AND METHODS We composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents' background, and their respective hospitals' trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27. RESULTS We obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, "often" in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level. CONCLUSION The number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings.
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Affiliation(s)
- André Bento
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Luís Ferreira
- Department of General Surgery, Hospital Central do Funchal, SESARAM, Funchal, Portugal
| | - Carlos Yánez Benitez
- General and Gastrointestinal Surgery, Royo Villanova Hospital, SALUD, Zaragoza, Spain
| | - Piotr Koleda
- Department of Medical Simulation, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences (SMS), University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Piotr Kozera
- Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Sérgio Baptista
- Department of Anesthesiology, Centro Hospitalar do Médio Tejo, EPE, Tomar, Portugal
| | - Carlos Mesquita
- Head of Clinic (Consultancy in General and Emergency Surgery and Trauma), Private Practice Coimbra, Coimbra, Portugal
| | - Henrique Alexandrino
- Department of General Surgery, Faculty of Medicine, Coimbra University Hospital Center, University of Coimbra, Praceta Mota Pinto, 3000-045, Coimbra, Portugal
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Taylor J, Gezer R, Ivkov V, Erdogan M, Hejazi S, Green R, Tallon JM, Tuyp B, Thakore J, Engels PT, Ackery A, Beckett A, Vogt K, Parry N, Heyd C, Coates A, Lampron J, MacPhail I. Do patient outcomes differ when the trauma team leader is a surgeon or non-surgeon? A multicentre cohort study. CAN J EMERG MED 2023:10.1007/s43678-023-00516-z. [PMID: 37184823 DOI: 10.1007/s43678-023-00516-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Trauma team leaders (TTLs) have traditionally been general surgeons; however, some trauma centres use a mixed model of care where both surgeons and non-surgeons (primarily emergency physicians) perform this role. The objective of this multicentre study was to provide a well-powered study to determine if TTL specialty is associated with mortality among major trauma patients. METHODS Data were collected from provincial trauma registries at six level 1 trauma centres across Canada over a 10-year period. We included adult trauma patients (age ≥ 18 yrs) who triggered the highest-level trauma activation. The primary outcome was the difference in risk-adjusted in-hospital mortality for trauma patients receiving initial care from a surgeon versus a non-surgeon TTL. RESULTS Overall, 12,961 major trauma patients were included in the analysis. Initial treatment was provided by a surgeon TTL in 57.8% (n = 7513) of cases, while 42.2% (n = 5448) of patients were treated by a non-surgeon TTL. Unadjusted mortality occurred in 11.6% of patients in the surgeon TTL group and 12.7% of patients in the non-surgeon TTL group (OR 0.87, 95% CI 0.78-0.98, p = 0.02). Risk-adjusted mortality was not significantly different between patients cared for by surgeon and non-surgeon TTLs (OR 0.92, 95% CI 0.80-1.06, p = 0.23). Furthermore, we did not observe differences in risk-adjusted mortality for any of the subgroups evaluated. CONCLUSIONS After risk adjustment, there was no difference in mortality between trauma patients treated by surgeon or non-surgeon TTLs. Our study supports emergency physicians performing the role of TTL at level 1 trauma centres.
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Affiliation(s)
- John Taylor
- Royal Columbian Hospital Emergency Department, New Westminster, BC, Canada.
| | | | - Vesna Ivkov
- Emergency and Trauma, Fraser Health Authority, Surrey, BC, Canada
| | - Mete Erdogan
- NS Health Trauma Program, Implementation Science, Nova Scotia Health, Halifax, NS, Canada
| | - Samar Hejazi
- Department of Evaluation and Research Services, Fraser Health Authority, Surrey, BC, Canada
| | - Robert Green
- Departments of Critical Care, Emergency Medicine, Anesthesia, and Surgery, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Trauma Program, Nova Scotia Health, Halifax, NS, Canada
| | - John M Tallon
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- Departments of Community Health and Epidemiology, Anesthesia and Surgery, Dalhousie University, Halifax, NS, Canada
| | | | - Jaimini Thakore
- Data, Evaluation and Analytics, Trauma Services BC, Fort Langley, BC, Canada
| | - Paul T Engels
- Trauma, General Surgery and Critical Care, Trauma and Acute Care Surgery, McMaster University, Hamilton, ON, Canada
| | - Alun Ackery
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Trauma and Neurosurgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew Beckett
- University of Toronto, Toronto, ON, Canada
- Canadian Forces Health Services, Ottawa, ON, Canada
| | - Kelly Vogt
- Western University, London, ON, Canada
- Trauma Program, London Health Sciences Centre, London, ON, Canada
| | - Neil Parry
- Trauma Program, Surgery and Critical Care Medicine, Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, ON, Canada
| | - Christopher Heyd
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Angela Coates
- Trauma Program Manager, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jacinthe Lampron
- General Surgery, Acute Care and Trauma, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Iain MacPhail
- Fraser Health Trauma Network, UBC, Vancouver, BC, Canada
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Yu TP, Chen YT, Ko PY, Wu CH, Yang TH, Hung KS, Wu PT, Wang CJ, Yen YT, Shan YS. Is delayed fixation worthwhile in patients with long bone fracture concomitant with mild traumatic brain injury? A propensity score-matched study. Injury 2023:110804. [PMID: 37225544 DOI: 10.1016/j.injury.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/06/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Early definite treatment for orthopedic patients is strongly advocated. However, a consensus has not been reached on the optimal timing of long bone fracture fixation for patients with associated mild traumatic brain injury (TBI). Surgeons lack evidence on the basis on which they should decide on the operation timing. METHODS We retrospectively reviewed the data of patients with mild TBI and lower extremity long bone fractures from 2010 to 2020. The patients receiving internal fixation within and after 24 h were defined as the early- and delayed-fixation groups. We compared the discharge Glasgow Coma Scale (GCS) scores, lengths of stay, and in-hospital complications. Propensity score matching (PSM) with multiple adjusted variables and a 1:1 matching ratio was applied to reduce selection bias. RESULTS In total, 181 patients were enrolled; 78 (43.1%) and 103 (56.9%) patients received early and delayed fracture fixation, respectively. After matching, each group had 61 participants and were statistically identical. The delayed group did not have better discharge GCS scores (early vs. delayed: 15.0 ± 0 vs. 15.0 ± 0.1; p = 0.158). The groups did not differ in their lengths of hospital stay (15.3 ± 10.6 vs. 14.8 ± 7.9; p = 0.789), intensive care unit stay (2.7 ± 4.3 vs. 2.7 ± 3.8; p = 0.947), or incidence of complications (23.0% vs. 16.4%; p = 0.494). CONCLUSIONS Delayed fixation for patients with lower extremity long bone fractures concurrent with mild TBI does not result in fewer complications or improved neurologic outcomes compared with early fixation. Delaying fixation may not be necessary to prevent the second hit phenomenon and has not demonstrated any clear benefits.
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Affiliation(s)
- Tzu-Ping Yu
- School of Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Chen
- School of Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Po-Yen Ko
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hsien Wu
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Tsung-Han Yang
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Kuo-Shu Hung
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ting Wu
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Jung Wang
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Yi-Ting Yen
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yan-Shen Shan
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Tang WR, Wu CH, Yang TH, Yen YT, Hung KS, Wang CJ, Shan YS. Impact of trauma teams on high grade liver injury care: a two-decade propensity score approach study in Taiwan. Sci Rep 2023; 13:5429. [PMID: 37012308 PMCID: PMC10070483 DOI: 10.1038/s41598-023-32760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 04/01/2023] [Indexed: 04/05/2023] Open
Abstract
High-grade liver laceration is a common injury with bleeding as the main cause of death. Timely resuscitation and hemostasis are keys to the successful management. The impact of in-hospital trauma system on the quality of resuscitation and management in patients with traumatic high-grade liver laceration, however, was rarely reported. We retrospectively reviewed the impact of team-based approach on the quality and outcomes of high-grade traumatic liver laceration in our hospital. Patients with traumatic liver laceration between 2002 and 2020 were enrolled in this retrospective study. Inverse probability of treatment weighting (IPTW)-adjusted analysis using the propensity score were performed. Outcomes before the trauma team establishment (PTTE) and after the trauma team establishment (TTE) were compared. A total of 270 patients with liver trauma were included. After IPTW adjustment, interval between emergency department arrival and managements was shortened in the TTE group with a median of 11 min (p < 0.001) and 28 min (p < 0.001) in blood test reports and duration to CT scan, respectively. Duration to hemostatic treatments in the TTE group was also shorter by a median of 94 min in patients receiving embolization (p = 0.012) and 50 min in those undergoing surgery (p = 0.021). The TTE group had longer ICU-free days to day 28 (0.0 vs. 19.0 days, p = 0.010). In our study, trauma team approach had a survival benefit for traumatic high-grade liver injury patients with 65% reduction of risk of death within 72 h (Odds ratio (OR) = 0.35, 95% CI = 0.14-0.86) and 55% reduction of risk of in-hospital mortality (OR = 0.45, 95% CI = 0.23-0.87). A team-based approach might contribute to the survival benefit in patients with traumatic high-grade liver laceration by facilitating patient transfer from outside the hospital, through the diagnostic examination, and to the definitive hemostatic procedures.
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Affiliation(s)
- Wen-Ruei Tang
- Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hsien Wu
- Division of General Surgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Division of Trauma, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan, Taiwan, 704
| | - Tsung-Han Yang
- Division of Trauma, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan, Taiwan, 704
| | - Yi-Ting Yen
- Division of Trauma, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan, Taiwan, 704
| | - Kuo-Shu Hung
- Division of Trauma, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan, Taiwan, 704
| | - Chih-Jung Wang
- Division of Trauma, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan, Taiwan, 704.
| | - Yan-Shen Shan
- Division of General Surgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Yuen T, Brindley PG, Senaratne JM. Simulation in cardiac critical care. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:129-134. [PMID: 36622806 DOI: 10.1093/ehjacc/zuac132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Medical simulation is a broad topic but at its core is defined as any effort to realistically reproduce a clinical procedure, team, or situation. Its goal is to allow risk-free practice-until-perfect, and in doing so, augment performance, efficiency, and safety. In medicine, even complex clinical situations can be dissected into reproducible parts that may be repeated and mastered, and these iterative improvements can add up to major gains. With our modern cardiac intensive care units treating a growing number of medically complex patients, the need for well-trained personnel, streamlined care pathways, and quality teamwork is imperative for improved patient outcomes. Simulation is therefore a potentially life-saving tool relevant to anyone working in cardiac intensive care. Accordingly, we believe that simulation is a priority for cardiac intensive care, not just a luxury. We offer the following primer on simulation in the cardiac intensive care environment.
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Affiliation(s)
- Tiffany Yuen
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Peter G Brindley
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Janek M Senaratne
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
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Fornander L, Berterö C, Molin I, Laukkanen K, Nilsson L, Björnström K. Development of trauma team cognition can be explained by "split vision": A grounded theory study. J Interprof Care 2023:1-9. [PMID: 36739575 DOI: 10.1080/13561820.2023.2171970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to explore interaction of interprofessional hospital trauma teams. A theory about how team cognition is developed through a dynamical process was established using grounded theory methodology. Video recordings of in-real-life resuscitations performed in the emergency ward of a Scandinavian mid-size urban hospital were collected and eligible for inclusion using theoretical sampling. By analyzing interactions during seven trauma resuscitations, the theory that trauma teams perform patient assessment and resuscitation by alternating between two process modes, the two main categories "team positioning" and "sensitivity to the patient," was generated. The core category "working with split vision" explicates how the teams interplay between the two modes to coordinate team focus with an emergent mental model of the specific situation. Split vision ensures that deeper aspects of the team, such as culture, knowledge, empathy, and patient needs are absorbed to continuously adapt team positioning and create precision in care for the specific patient.
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Affiliation(s)
- Liselott Fornander
- Department of Anaesthesiology and Intensive Care, Vrinnevi Hospital, Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Carina Berterö
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ida Molin
- Department of Emergency Medicine, Vrinnevi Hospital, Norrköping and Centre for Disaster Medicine and Traumatology, Linköping, Sweden
| | - Kati Laukkanen
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care, University Hospital, Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Karin Björnström
- Department of Anaesthesiology and Intensive Care, University Hospital, Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Zitek T, Pagano K, Mechanic OJ, Farcy DA. Assessment of Trauma Team Activation Fees by US Region and Hospital Ownership. JAMA Netw Open 2023; 6:e2252520. [PMID: 36692878 PMCID: PMC10408274 DOI: 10.1001/jamanetworkopen.2022.52520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/01/2022] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Trauma centers must be readily equipped to handle a variety of life-threatening injuries and consequently may charge a fee for the activation of their trauma team. Regional and hospital-related variations in trauma activation fees across the US have not been formally assessed. OBJECTIVE To evaluate the variability of trauma activation fees from trauma centers across the US and examine whether certain hospital characteristics are associated with higher activation fees. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the American College of Surgeons website to identify all trauma centers in the US that were listed as verified from inception of the verification database through March 4, 2022 (N = 546). Five military hospitals were excluded, and trauma activation fees could not be found for 18 trauma centers; the remaining 523 hospitals were included in the analysis. Each hospital's publicly available chargemaster (a comprehensive list of a hospital's products, procedures, and services) was searched to obtain its trauma activation fees. Two levels of trauma activation fees were recorded: tier 1 (full activation) and tier 2 (partial activation). Hospital-specific data were obtained from the American Hospital Association website. All data were collected between January 2 and March 11, 2022. Linear regression analyses were performed to assess potential associations between hospital characteristics (type of control [for profit, government, church, or other nonprofit], hospital system [owner], number of staffed beds, and academic vs nonacademic status) and trauma activation fees. MAIN OUTCOMES AND MEASURES Median and mean trauma activation fees nationally and stratified by location, hospital system, and other hospital characteristics. RESULTS Of 523 trauma centers included in the analysis, most were located in the Midwest (180 centers) and West (129 centers). There were 176 adult level I trauma centers and 200 adult level II trauma centers; 69 centers had for-profit status, and 415 were academic. Overall, the median (IQR) tier 1 trauma activation fee was $9500 ($5601-$17 805), and the mean (SD) tier 1 trauma activation fee was $13 349 ($11 034); these fees ranged from $1000 to $61 734. Median (IQR) trauma activation fees were highest in the West ($18 099 [$10 741-$$27 607]), especially in California, where the median (IQR) activation fee was $24 057 ($15 979-$33 618). Trauma activation fees were also higher at for-profit hospitals, most of which were owned by the HCA Healthcare system, which had 43 trauma centers and a median (IQR) tier 1 trauma activation fee of $29 999 ($20 196-$37 589). CONCLUSIONS AND RELEVANCE In this study, trauma activation fees varied widely among hospitals in the US. Regional variation in these fees was substantial, with hospitals in the West charging substantially more than those in other locations. In addition, for-profit hospitals charged more than other types of hospitals. These findings suggest that some patients with serious traumatic injuries will incur disproportionately high trauma activation fees depending on the trauma center to which they are brought. Therefore, standardization of trauma activation fees is warranted.
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Affiliation(s)
- Tony Zitek
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
- Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami
| | - Kristina Pagano
- Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami
| | - Oren J. Mechanic
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
- Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami
| | - David A. Farcy
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
- Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami
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Montserrat Ortiz N, Trujillano Cabello J, Badia Castelló M, Vilanova Corsellas J, Jimenez Jimenez G, Rubio Ruiz J, Pujol Freire A, Morales Hernandez D, Servia Goixart L. Implantación de un equipo de asistencia al trauma grave. Análisis de la activación y tiempos de asistencia en pacientes ingresados en UCI. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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van Maarseveen OEC, Ham WHW, Leenen LPH. The effect of an on-site trauma surgeon during resuscitations of severely injured patients. BMC Emerg Med 2022; 22:163. [PMID: 36171543 PMCID: PMC9520822 DOI: 10.1186/s12873-022-00724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the timely involvement of trauma surgeons is widely accepted as standard care in a trauma center, there is an ongoing debate regarding the value of an on-site attending trauma surgeon compared to an on-call trauma surgeon. The aim of this study was to evaluate the effect of introducing an on-site trauma surgeons and the effect of their presence on the adherence to Advanced Trauma Life Support (ATLS) related tasks and resuscitation pace in the trauma bay. METHODS The resuscitations of severely injured (ISS > 15) trauma patients 1 month before and 1 month after the introduction of an on-site trauma surgeon were assessed using video analysis. The primary outcome was total resuscitation time. Second, time from trauma bay admission until tasks were performed, and ATLS adherence were assessed. RESULTS Fifty-eight videos of resuscitations have been analyzed. After the introduction of an on-site trauma surgeon, the mean total resuscitation time was 259 seconds shorter (p = 0.03) and seven ATLS related tasks (breathing assessment, first and second IV access, EKG monitoring and abdominal, pelvic, and long bone examination; were performed significantly earlier during trauma resuscitation (p ≤ 0.05). Further, we found a significant enhancement to the adherence of six ATLS related tasks (Airway assessment, application of a rigid collar, IV access; EKG monitoring, log roll, and pronouncing results of arterial blood gas analysis; p-value ≤0.05). CONCLUSION Having a trauma surgeon on-site during trauma resuscitations of severely injured patients resulted in improved processes in the trauma bay. This demonstrates the need of direct involvement of trauma surgeons in institutions treating severely injured patients.
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Affiliation(s)
- Oscar E C van Maarseveen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Wietske H W Ham
- Emergency Department, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.,University of Applied Science Utrecht, Institute of Nursing Studies, Utrecht, The Netherlands
| | - Loek P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
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Variation of in-hospital trauma team staffing: new resuscitation, new team. BMC Emerg Med 2022; 22:161. [PMID: 36109695 PMCID: PMC9479395 DOI: 10.1186/s12873-022-00715-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Non-technical errors, such as insufficient communication or leadership, are a major cause of medical failures during trauma resuscitation. Research on staffing variation among trauma teams on teamwork is still in their infancy. In this study, the extent of variation in trauma team staffing was assessed. Our hypothesis was that there would be a high variation in trauma team staffing.
Methods
Trauma team composition of consecutive resuscitations of injured patients were evaluated using videos. All trauma team members that where part of a trauma team during a trauma resuscitation were identified and classified during a one-week period. Other outcomes were number of unique team members, number of new team members following the previous resuscitation and new team members following the previous resuscitation in the same shift (Day, Evening, Night).
Results
All thirty-two analyzed resuscitations had a unique trauma team composition and 101 unique members were involved. A mean of 5.71 (SD 2.57) new members in teams of consecutive trauma resuscitations was found, which was two-third of the trauma team. Mean team members present during trauma resuscitation was 8.38 (SD 1.43). Most variation in staffing was among nurses (32 unique members), radiology technicians (22 unique members) and anesthetists (19 unique members). The least variation was among trauma surgeons (3 unique members) and ER physicians (3 unique members).
Conclusion
We found an extremely high variation in trauma team staffing during thirty-two consecutive resuscitations at our level one trauma center which is incorporated in an academic teaching hospital. Further research is required to explore and prevent potential negative effects of staffing variation in trauma teams on teamwork, processes and patient related outcomes.
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Robertson C, Jones T, Southwell P. “Unchaining the doctor from the desk”: deliberate team-based care in action. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-03-2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeAs a model of integrated care (IC), deliberate team-based care (DTBC) can help address workforce shortages facing rural communities by improving the health and wellbeing of healthcare providers. This study focuses on a GP practice implementing DTBC in rural Australia. The aim of this research was to understand the perspectives of the healthcare workers involved and to ascertain factors impacting on the day to day running of the model, patient care and clinician work-life. The authors conducted a qualitative study on the experiences of the DTBC workers.Design/methodology/approachTeam members were invited to participate in semi-structured interviews (n = 9). Interviews were analysed using an iterative thematic analysis, summarised, collated and explored for emergent themes.FindingsKey themes included: creating change from old ways of doing things, development and implementation processes outlining how the model evolved and how it ran from day to day, model outcomes for patients and clinicians, as well as practical considerations like funding, technology and time.Originality/valueBuilding DTBC from the ground up has produced a high functioning team who demonstrate trust and equality, share information freely and all have a voice which is heard and respected. By acting as a champion and a leader, the GP has created a psychologically safe environment allowing the team to share knowledge, collaborate in problem solving and provide effective patient care which is holistic and community grounded. This work environment holds promise for creating improved work-life for rural clinicians and potential for workforce retention.
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van Maarseveen OEC, Ham WHW, van Cruchten S, Duhoky R, Leenen LPH. Evaluation of validity and reliability of video analysis and live observations to assess trauma team performance. Eur J Trauma Emerg Surg 2022; 48:4797-4803. [PMID: 35817942 DOI: 10.1007/s00068-022-02004-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/15/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION A trauma resuscitation is dynamic and complex process in which failures could lead to serious adverse events. In several trauma centers, evaluation of trauma resuscitation is part of a hospital's quality assessment program. While video analysis is commonly used, some hospitals use live observations, mainly due to ethical and medicolegal concerns. The aim of this study was to compare the validity and reliability of video analysis and live observations to evaluate trauma resuscitations. METHODS In this prospective observational study, validity was assessed by comparing the observed adherence to 28 advanced trauma life support (ATLS) guideline related tasks by video analysis to life observations. Interobserver reliability was assessed by calculating the intra class coefficient of observed ATLS related tasks by live observations and video analysis. RESULTS Eleven simulated and thirteen real-life resuscitations were assessed. Overall, the percentage of observed ATLS related tasks performed during simulated resuscitations was 10.4% (P < 0.001) higher when the same resuscitations were analysed using video compared to live observations. During real-life resuscitations, 8.7% (p < 0.001) more ATLS related tasks were observed using video review compared to live observations. In absolute terms, a mean of 2.9 (during simulated resuscitations) respectively 2.5 (during actual resuscitations) ATLS-related tasks per resuscitation were not identified using live observers, that were observed through video analysis. The interobserver variability for observed ATLS related tasks was significantly higher using video analysis compared to live observations for both simulated (video analysis: ICC 0.97; 95% CI 0.97-0.98 vs. live observation: ICC 0.69; 95% CI 0.57-0.78) and real-life witnessed resuscitations (video analyse 0.99; 95% CI 0.99-1.00 vs live observers 0.86; 95% CI 0.83-0.89). CONCLUSION Video analysis of trauma resuscitations may be more valid and reliable compared to evaluation by live observers. These outcomes may guide the debate to justify video review instead of live observations.
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Affiliation(s)
- Oscar E C van Maarseveen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Wietske H W Ham
- Emergency Department, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Institute of Nursing Studies, University of Applied Science, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands
| | - Stijn van Cruchten
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rauand Duhoky
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Emergency Department, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Hietbrink F, Mohseni S, Mariani D, Naess PA, Rey-Valcárcel C, Biloslavo A, Bass GA, Brundage SI, Alexandrino H, Peralta R, Leenen LPH, Gaarder T. What trauma patients need: the European dilemma. Eur J Trauma Emerg Surg 2022:10.1007/s00068-022-02014-w. [PMID: 35798972 DOI: 10.1007/s00068-022-02014-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
Abstract
There is a need for implementation and maturation of an inclusive trauma system in every country in Europe, with patient centered care by dedicated surgeons. This process should be initiated by physicians and medical societies, based on the best available evidence, and supported and subsequently funded by the government and healthcare authorities. A systematic approach to organizing all aspects of trauma will result in health gain in terms of quality of care provided, higher survival rates, better functional outcomes and quality of life. In addition, it will provide reliable data for both research, quality improvement and prevention programs. Severely injured patients need surgeons with broad technical and non-technical competencies to provide holistic, inclusive and compassionate care. Here we describe the philosophy of the surgical approach and define the necessary skills for trauma, both surgical and other, to improve outcome of severely injured patients. As surgery is an essential part of trauma care, surgeons play an important role for the optimal treatment of trauma patients throughout and after their hospital stay, including the intensive care unit (ICU). However, in most European countries, it might not be obvious to either the general public, patients or even the physicians that the surgeon must assume this responsibility in the ICU to optimize outcomes. The aim of this paper is to define key elements in terms of trauma systems, trauma-specific surgical skills and active critical care involvement, to organize and optimize trauma care in Europe.
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Affiliation(s)
- Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Diego Mariani
- Department of General Surgery, ASST Ovest Milanese, Milan, Italy
| | - Päl Aksel Naess
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
| | | | - Alan Biloslavo
- General Surgery Department, Cattinara University Hospital, Trieste, Italy
| | - Gary A Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, USA
| | - Susan I Brundage
- Department of Surgery, R Adams Cowley Shock Trauma Center, Baltimore, USA
| | | | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic
- Hamad Injury Prevention Program, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tina Gaarder
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
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Chowdhury S, Almarhabi M, Varghese B, Leenen L. Trauma Resuscitation Training: An Evaluation of Nurses' Knowledge. J Trauma Nurs 2022; 29:192-200. [PMID: 35802054 DOI: 10.1097/jtn.0000000000000661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Trauma resuscitation in the emergency department involves coordinated, well-equipped, and trained health care providers to make essential, prudent, and expedient management decisions. During resuscitation, health care providers' knowledge and skills are critical in minimizing the potential risks of mortality and morbidity. OBJECTIVE This study aimed to evaluate the impact of training on nurses' knowledge and confidence regarding trauma resuscitation and whether there was any difference between participants with and without previous trauma training. METHODS This study used a pre- and posttraining test study design to evaluate the effects of an intensive 8-hr trauma resuscitation training program on nurses' knowledge from January 2018 to August 2021. The training program consisted of lectures and patient scenarios covering initial assessment, resuscitation, and management priorities for trauma patients in life-threatening situations, stressing the principles of the trauma team approach. RESULTS A total of 128 nurses participated in 16 courses conducted during the study period. This study found significant improvement in nurses' knowledge after the training (pre- and posttraining median [interquartile range, IQR] test scores 5 [4-6] vs. 9 [8-9], p < .001). There was no significant difference in pretraining test scores between the participants with previous trauma training and those without training (median [IQR] test scores 5 [4-6] vs. 4 [4-5], p = .751). CONCLUSIONS Trauma resuscitation training affects nurses' knowledge improvement, emphasizing the need for training trauma care professionals to provide adequate care.
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Affiliation(s)
- Sharfuddin Chowdhury
- Trauma Center, King Saud Medical City, Riyadh, Saudi Arabia (Dr Chowdhury and Ms Varghese); Emergency and Critical Care Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia (Ms Almarhabi); and Department of Trauma, University Medical Center Utrecht, Utrecht, the Netherlands (Dr Leenen)
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Nichttraumatologisches Schockraummanagement – ein einheitliches Konzept ist dringend notwendig! Notf Rett Med 2022. [DOI: 10.1007/s10049-021-00850-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Maris M, Berben SAA, Verhoef W, van Grunsven P, Tan ECTH. The quality of pre-announcement communication and the accuracy of estimated arrival time in critically ill patients, a prospective observational study. BMC Emerg Med 2022; 22:44. [PMID: 35305570 PMCID: PMC8933928 DOI: 10.1186/s12873-022-00601-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Efficient communication between (helicopter) emergency medical services ((H)EMS) and healthcare professionals in the emergency department (ED) is essential to facilitate appropriate team mobilization and preparation for critically ill patients. A correct estimated time of arrival (ETA) is crucial for patient safety and time-management since all team members have to be present, but needless waiting must be avoided. The aim of this study is to investigate the quality of the pre-announcement and the accuracy of the ETA.
Methods
A prospective observational study was conducted in potentially critically ill/injured patients transported to the ED of a Level I trauma center by the (H)EMS. Research assistants observed time slots prior to arrival at the ED and during the initial assessment, using a stopwatch and an observation form. Information on the pre-announcement (including mechanisms of injury, vital signs, and the ETA) is also collected.
Results
One hundred and ninety-three critically ill/injured patients were included. Information in the pre-announcement was often incomplete; in particular vital signs (86%). Forty percent of the announced critically ill patients were non-critical at arrival in the ED. The observed time of arrival (OTA) for 66% of the patients was later than the provided ETA (median 5:15 min) and 19% of the patients arrived sooner (3:10 min). Team completeness prior to the arrival of the patient was achieved for 66% of the patients.
Conclusions
The quality of the pre-announcement is moderate, sometimes lacking essential information on vital signs. Forty percent of the critically ill patients turned out to be non-critical at the ED. Furthermore, the ETA was regularly inaccurate and team completeness was insufficient. However, none of the above was correlated to the rate of complications, mortality, LOS, ward of admission or discharge location.
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Chong EY, Goh DWX, Lim AHS, Goh SSN, Balasubramaniam S. A systematic review of penetrating perineal trauma in a civilian setting. Eur J Trauma Emerg Surg 2022; 48:4365-4383. [PMID: 35262749 DOI: 10.1007/s00068-022-01908-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Penetrating injuries to the perineum and associated pelvic organs have largely been reported in the military. Given the rarity of presentation and unique clinical characteristics of these injuries, we set out to address the gap in the literature in civilian settings. METHODS A systematic review of studies addressing penetrating perineal trauma from January 2000 to April 2021 was performed. Outcomes of interest were the epidemiology, associated injuries, management, follow-up, and patient outcomes. RESULTS 26 studies were included in this review, reporting on a total of 2316 patients. Most injuries occurred in males (88.1%), with gunshot wounds (88.2%) representing the most common aetiology, followed by knife wounds (5.0%), impalement (3.1%), coital injuries/sexual assault (1.5%), and others (2.4%). Regarding associated injuries, anorectal (n = 1419, 69.4%), bladder (n = 351, 32.4%), penile (n = 282, 20.8%), scrotal (n = 375, 27.7%), and testicular (n = 229, 16.9%) occurred frequently. Bony injuries involved the pelvis (n = 88, 8.1%) and femoral fractures (n = 5, 0.5%), while soft-tissue injuries involved the inguinal region (n = 19, 1.6%) and buttocks (n = 14, 1.3%). Vascular injuries occurred in 79 (7.8%) patients. Regarding patient outcomes, 65 (4.8%) deaths were reported, and significant morbidity was detected with a mean injury severity score of 18.4 detected in the cohort. In terms of complications of injury, wound/infective complications (n = 135, 61.3%) and fistula formation/leakage (n = 16, 0.7%) featured prominently. CONCLUSION Penetrating perineal trauma in the civilian population poses a considerable challenge to clinicians, compounded by the potential for multisystem injury requiring involvement of different medical and surgical specialties.
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Affiliation(s)
- Elliot Yeung Chong
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore city, Singapore
| | - Daniel Wen Xiang Goh
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore city, Singapore
| | - Angela Hui-Shan Lim
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore city, Singapore
| | - Serene Si Ning Goh
- Department of General Surgery, Tan Tock Seng Hospital, Singapore city, Singapore
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Howlett O, Gleeson R, Jackson L, Rowe E, Truscott M, Maggs JA. Family support role in hospital rapid response teams: a scoping review. JBI Evid Synth 2022; 20:2001-2024. [PMID: 35249996 DOI: 10.11124/jbies-21-00189] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to identify and understand the primary research investigating the family support role in hospital rapid response teams. INTRODUCTION Individual studies have described the benefits of providing emotional and psychosocial support to family members of a person receiving emergency medical care from a rapid response team in a hospital setting. To the authors' knowledge, there are no studies that have identified and described these studies together. INCLUSION CRITERIA All empirical qualitative and quantitative papers investigating a family support role delivered in a rapid response team in a hospital setting were included. METHODS This review followed a published a priori protocol. The four databases searched were MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane, and OpenGrey. The search strategy was not limited by the age of participants within studies or by the language the study was published in. The title and abstracts of all citations were reviewed by two authors independently, and studies meeting the inclusion criteria were considered for inclusion. The full text of the remaining studies were retrieved and reviewed by two authors independently. Data from eligible studies were extracted by two authors separately using a predetermined data extraction form and summarized in table and narrative format. RESULTS After a full-text review of 110 studies, six studies met all inclusion criteria. All rapid response teams were set in hospital locations, and the studies were set in four nations. Charted data demonstrates that the family support role had been investigated predominantly by qualitative study designs from the perspective of staff delivering the role. One study reported health outcomes of family members who received family support. In all studies, the family support role was part of a resuscitation rapid response team. Family support was provided at all stages of the resuscitation procedure. The family support role was not a consistently defined role, with the activities of the family support person reported differently between studies. Twenty-five varying support activities were described, such as attending to the family members' comfort needs, explaining the process of resuscitation, and providing guidance to the family member. In all studies, the family support role was available to support the family witnessing the resuscitation. The family support role was delivered by professionals from varying disciplines, including social work, nursing, health care workers, and health care chaplains. CONCLUSIONS Family support roles are varied and are carried out by health professionals of various backgrounds highlighting the need to consider the support and training needs of the person performing the role. Future research using evaluation methods is recommended to deepen the understanding about the family support role in hospital-based rapid response teams.
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Affiliation(s)
- Owen Howlett
- Research and Innovation, Bendigo Health, Bendigo, Vic, Australia La Trobe Rural Health School, La Trobe University, Bendigo, Vic, Australia Social Work Department, Bendigo Health, Bendigo, Vic, Australia
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Maarseveen OECV, Ham WHW, Huijsmans RLN, Leenen LPH. The pace of a trauma resuscitation: experience matters. Eur J Trauma Emerg Surg 2022; 48:2503-2510. [PMID: 35141771 PMCID: PMC9192480 DOI: 10.1007/s00068-021-01838-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
Purpose Resuscitation quality and pace depend on effective team coordination, which can be facilitated by adequate leadership. Our primary aim was to assess the influence of trauma team leader experience on resuscitation pace. Second, we investigated the influence of injury severity on resuscitation pace. Methods The trauma team leaders were identified (Staff trauma surgeon vs Fellow trauma surgeon) and classified from video analysis during a 1-week period. Resuscitations were assessed for time to the treatment plan, total resuscitation time, and procedure time. Furthermore, patient and resuscitation characteristics were assessed and compared: age, gender, Injury Severity Score, Glasgow Coma Scale < 9, and the number (and duration) of surgical procedures during initial resuscitation. Correlations between total resuscitation time, Injury Severity Score, and time to treatment plan were calculated. Results After adjustment for the time needed for procedures, the time to treatment plan and total resuscitation time was significantly shorter in resuscitations led by a Staff trauma surgeon compared to a Fellow trauma surgeon (median 648 s (IQR 472–813) vs 852 s (IQR 694–1256); p 0.01 resp. median 1280 s (IQR 979–1494) vs 1535 s (IQR 1247–1864), p 0.04). Surgical procedures were only performed during resuscitations led by Staff trauma surgeons (4 thorax drains, 1 endotracheal intubation, 1 closed fracture reduction). Moreover, a significant negative correlation (r: – 0.698, p < 0.01) between Injury Severity Score and resuscitation time was found. Conclusion Experienced trauma team leaders may positively influence the pace of the resuscitation. Moreover, we found that the resuscitation pace increases when the patient is more severely injured.
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Affiliation(s)
- Oscar E C van Maarseveen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Wietske H W Ham
- Emergency Department, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Institute of Nursing Studies, University of Applied Science, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands
| | - Roel L N Huijsmans
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Perlman R, Lo J, Po J, Baldini G, Amir A, Zhang V. Trauma and the Anesthesiologist: an International Perspective. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-021-00507-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Trauma Bay Time Clocks: Influence on Emergency Department Length of Stay. J Trauma Nurs 2021; 28:269-274. [PMID: 34210948 DOI: 10.1097/jtn.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND To monitor the time elapsed since patient arrival in the emergency department, Trauma Services at the study institution installed a large digital stopwatch timer placed at the head of each trauma bay on June 5, 2017. This quality improvement endeavor became an essential component of performance evaluation. OBJECTIVE The purpose of the study is to measure the impact of trauma bay time clocks on emergency department length of stay. METHODS This is a retrospective before-and-after study of trauma activation patients between June 2015 and May 2019. Two 24-month intervals were compared before and after installation of time clocks. RESULTS In full activation patients, outcomes of emergency department length of stay ≤50 min (39.2% vs. 61.7%, p < .001) and time to transfer to intensive care unit ≤56 min (45.3% vs. 55.1%, p = .002) were significantly favorable in the postimplementation phase. Time to first computed tomography scan and time to first operating room from arrival to the emergency department were comparable between both phases. For limited activation patients, positive changes were noted in emergency department length of stay ≤87 min (41.4% vs. 60.6%, p < .001), time to first computed tomography scan ≤32 min (47.7% vs. 53.0%, p = .015), and time to transfer to intensive care unit ≤74 min (50.2% vs. 57.2%, p = .008). Time to first operating room remained comparable between two periods. CONCLUSIONS The study institution improved their provision of immediate care by using time clocks in trauma bays. This is a simple and cost-effective intervention and may benefit similar institutions.
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Howlett O, Gleeson R, Arntzen H, Truscott M, Adams R, Howie C, French R, Rowe E, Maggs JA, Kennedy S, Jackson L. The family support role in hospital rapid response teams: a scoping review protocol. JBI Evid Synth 2021; 19:1481-1488. [PMID: 33278265 DOI: 10.11124/jbies-20-00164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review is to identify and understand how a family support role has been delivered in rapid response teams in hospital settings. INTRODUCTION A family support role in a hospital rapid response team is a designated position that is responsible for supporting the family members of people being medically attended to during a hospital rapid response. Support may include the provision of guidance to the family regarding a hospital procedure, support whilst witnessing the rapid response, or assisting the family to process their emotional response. This review will assist in identifying the ways in which the family support role is delivered in rapid response teams within a hospital environment. INCLUSION CRITERIA Family support must be delivered by a person who has a designated family support role within a rapid response team in a hospital setting. Studies will not be limited to geographical location, gender, or culture. Studies are not limited to year of publication or methodological design. METHODS Databases will include MEDLINE (Ovid), Embase (Ovid), CINAHL, and Cochrane. Gray literature will be searched with predetermined search criteria. Two independent authors will be used to screen articles and perform data extraction on a predetermined data extraction form. A narrative Summary of Findings is planned, alongside a presentation of the data in diagrammatic or tabular form.
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Affiliation(s)
- Owen Howlett
- Research and Innovation, Bendigo Health, Bendigo, Vic, Australia.,La Trobe Rural Health School, La Trobe University, Bendigo, Vic, Australia
| | - Rebecca Gleeson
- Social Work Department, Bendigo Health, Bendigo, Vic, Australia
| | - Heidi Arntzen
- La Trobe Rural Health School, La Trobe University, Bendigo, Vic, Australia
| | - Myf Truscott
- Social Work Department, Bendigo Health, Bendigo, Vic, Australia
| | - Robin Adams
- Social Work Department, Bendigo Health, Bendigo, Vic, Australia
| | - Caitlin Howie
- Social Work Department, Bendigo Health, Bendigo, Vic, Australia
| | - Rebecca French
- Social Work Department, Bendigo Health, Bendigo, Vic, Australia
| | - Elizabeth Rowe
- Social Work Department, Bendigo Health, Bendigo, Vic, Australia
| | | | | | - Lana Jackson
- Social Work Department, Bendigo Health, Bendigo, Vic, Australia
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[Resuscitation room management : Today and tomorrow]. Med Klin Intensivmed Notfmed 2021; 116:375-376. [PMID: 34043034 DOI: 10.1007/s00063-021-00809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
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Präklinische Bluttransfusion bei lebensbedrohlicher Blutung – erweiterte lebensrettende Therapieoptionen durch das Konzept Medical Intervention Car. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00897-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDas Medical Intervention Car (MIC) der Klinik für Anästhesiologie des Universitätsklinikums Heidelberg (UKHD) stellt ein neuartiges experimentelles Versorgungskonzept dar, welches zusätzliche Expertise und bisher nur innerklinisch etablierte Interventionen in der Präklinik verfügbar macht. Hierzu zählen die Transfusion von Blutprodukten, die Notfallthorakotomie, die „resuscitative endovascular balloon occlusion of the aorta“ (REBOA) sowie die Möglichkeit zur extrakorporalen kardiopulmonalen Reanimation (eCPR). Anhand der Fallvorstellung eines jungen Patienten, der sich mit einer Kettensäge in der Leiste verletzte und einen hämorrhagisch bedingten Kreislaufstillstand erlitt, wird insbesondere die Möglichkeit der lebensrettenden Transfusion diskutiert. In diesem Einsatz führte ein integratives präklinisches Versorgungskonzept, bestehend aus Rettungswagen, Notarzteinsatzfahrzeug und MIC, zur Wiederherstellung des Spontankreislaufs und einer vollständigen zerebralen Erholung des Patienten.
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van Wessem KJP, Leenen LPH. Process related decisions and in-hospital transport times in polytrauma patients benefit from 24/7 in-house presence of trauma surgeons. Injury 2021; 52:189-194. [PMID: 32958341 DOI: 10.1016/j.injury.2020.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/31/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Time and cause of death in polytrauma has shifted due to improvements in trauma and critical care. These include logistical improvements with dedicated trauma teams and in-house trauma surgeons. This study investigated in-hospital transport times and influence of process related decisions on mortality in polytrauma patients. STUDY DESIGN A 6.5-year prospective study included consecutive polytrauma patients ≥15 years admitted to a Level-1 Trauma Center ICU with 24/7 in-house trauma surgeons. Demographics, physiologic parameters, pre- and in-hospital transport times were prospectively collected. Data are presented as median(IQR). RESULTS 391 patients were included with median ISS of 29(22-36). 82 patients(21%) had a SBP≤90 mmHg on arrival in ED. 44 patients went from ED directly to OR for urgent surgery, all others had CT prior to OR and/or ICU. Patients who went directly to OR from ED had median transport time of 28(23-37) min. Patients who had CT after ED had median transport time of 31(25-42) min. 74(19%) patients died, majority caused by TBI(70%). Ten patients died <24 h after trauma (4 hemorrhage,3 TBI,2 ischemia,1 cardiac injury), 9 of them went straight to OR from ED. Death could possibly have been prevented in 1 patient (1%) who later died of hemorrhage but went to CT before urgent surgery. CONCLUSION In-hospital transport times from ED were half an hour regardless of the following destination (OR/CT). Decisions for transport order based on clinical signs in primary survey were rapid and accurate. This could be attributed to dedicated trauma teams and 24/7 physical presence of trauma surgeons.
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Affiliation(s)
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Netherlands
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37
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Weile J, Nebsbjerg MA, Ovesen SH, Paltved C, Ingeman ML. Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature. Adv Simul (Lond) 2021; 6:3. [PMID: 33472706 PMCID: PMC7816464 DOI: 10.1186/s41077-021-00154-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of simulation-based team training has increased over the past decades. Simulation-based team training within emergency medicine and critical care contexts is best known for its use by trauma teams and teams involved in cardiac arrest. In the domain of emergency medicine, simulation-based team training is also used for other typical time-critical clinical presentations. We aimed to review the existing literature and current state of evidence pertaining to non-technical skills obtained via simulation-based team training in emergency medicine and critical care contexts, excluding trauma and cardiac arrest contexts. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Before the initiation of the study, the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database. We conducted a systematic literature search of 10 years of publications, up to December 17, 2019, in the following databases: PubMed/MEDLINE, EMBASE, Cochrane Library, and CINAHL. Two authors independently reviewed all the studies and extracted data. RESULTS Of the 456 studies screened, 29 trials were subjected to full-text review, and 13 studies were included in the final review. None of the studies was randomized controlled trials, and no studies compared simulation training to different modalities of training. Studies were heterogeneous; they applied simulation-training concepts of different durations and intensities and used different outcome measures for non-technical skills. Two studies reached Kirkpatrick level 3. Out of the remaining 11 studies, nine reached Kirkpatrick level 2, and two reached Kirkpatrick level 1. CONCLUSIONS The literature on simulation-based team training in emergency medicine is heterogeneous and sparse, but somewhat supports the hypothesis that simulation-based team training is beneficial to teams' knowledge and attitudes toward non-technical skills (Kirkpatrick level 2). Randomized trials are called for to clarify the effect of simulation compared to other modalities of team training. Future research should focus on the transfer of skills and investigate improvements in patient outcomes (Kirkpatrick level 4).
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Affiliation(s)
- Jesper Weile
- Emergency Department, Regional Hospital Horsens, Horsens, Denmark. .,Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark.
| | - Mette Amalie Nebsbjerg
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark
| | - Stig Holm Ovesen
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark.,Department of Internal Medicine, Regional Hospital West Jutland, Herning, Denmark
| | | | - Mads Lind Ingeman
- Department of Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
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Sethuraman KN, Chang WTW, Zhou AL, Xia B, Gingold DB, McCunn M. Collaboration and Decision-Making on Trauma Teams: A Survey Assessment. West J Emerg Med 2021; 22:278-283. [PMID: 33856312 PMCID: PMC7972389 DOI: 10.5811/westjem.2020.10.48698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/04/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Leadership, communication, and collaboration are important in well-managed trauma resuscitations. We surveyed resuscitation team members (attendings, fellows, residents, and nurses) in a large urban trauma center regarding their impressions of collaboration among team members and their satisfaction with patient care decisions. Methods The Collaboration and Satisfaction About Care Decisions in Trauma (CSACD.T) survey was administered to members of ad hoc trauma teams immediately after resuscitations. Survey respondents self-reported their demographic characteristics; the CSACD.T scores were then compared by gender, occupation, self-identified leader role, and level of training. Results The study population consisted of 281 respondents from 52 teams; 111 (39.5%) were female, 207 (73.7%) were self-reported White, 78 (27.8%) were nurses, and 140 (49.8%) were physicians. Of the 140 physician respondents, 38 (27.1%) were female, representing 13.5% of the total surveyed population. Nine of the 52 teams had a female leader. Men, physicians (vs nurses), fellows (vs attendings), and self-identified leaders trended toward higher satisfaction across all questions of the CSACD.T. In addition to the comparison groups mentioned, women and general team members (vs non-leaders) gave lower scores. Conclusion Female residents, nurses, general team members, and attendings gave lower CSACD.T scores in this study. Identification of nuances and underlying causes of lower scores from female members of trauma teams is an important next step. Gender-specific training may be necessary to change negative team dynamics in ad hoc trauma teams.
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Affiliation(s)
- Kinjal N Sethuraman
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland
| | - Wan-Tsu W Chang
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland
| | - Amy L Zhou
- University of Maryland, College Park, Maryland
| | - Boyan Xia
- University of Maryland, College Park, Maryland
| | - Daniel B Gingold
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Maureen McCunn
- University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland.,University of Maryland School of Medicine, Department of Anesthesiology, Baltimore, Maryland
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Uribe Buritica FL, Carvajal SM, Torres N, Bustamante Cristancho LA, García Marín AF. Equipos de trauma: realidad mundial e implementación en un país en desarrollo. Descripción narrativa. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El trauma es una de las entidades con mayor morbimortalidad en el mundo. Los equipos especializados en la atención del paciente traumatizado son llamados <<equipos de trauma>>. Dichos equipos surgieron de la necesidad de brindar tratamiento oportuno multidisciplinario a individuos con heridas que condicionan gran severidad en la guerra; sin embargo, con el paso del tiempo se trasladaron al ámbito civil, generando un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad.
El objetivo de este estudio fue describir el proceso de desarrollo de los equipos de trauma a nivel mundial y la experiencia en nuestra institución en el suroccidente colombiano.
Métodos. Se realizó una búsqueda en la base de datos PUBMED, que incluyó revisiones sistemáticas, metaanálisis, revisiones de Cochrane, ensayos clínicos y series de casos.
Resultados. Se incluyeron 41 estudios para esta revisión narrativa, y se observó que el tiempo de permanencia en el Emergencias, el tiempo de traslado a cirugía, la mortalidad y las complicaciones asociadas al trauma fueron menores cuando se implementan equipos de trauma.
Discusión. El diseño de un sistema de atención y valoración horizontal de un paciente con traumatismos severos produce un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. Se hace necesario establecer los parámetros operativos necesarios en las instituciones de salud de alta y mediana complejidad en nuestro país para implementar dichos equipos de trabajo.
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Beeharry MW, Moqeem K. The London Major Trauma Network System: A Literature Review. Cureus 2020; 12:e12000. [PMID: 33324530 PMCID: PMC7732139 DOI: 10.7759/cureus.12000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Trauma is one of the leading causes of death and disability worldwide and is a major global public health problem. The provision of trauma care has been substandard in England and Wales prior to the implementation of an inclusive major trauma network system in London in 2010 and subsequently across the rest of England two years later. The implementation of the London trauma system has brought about improvements to the delivery of trauma care by decreasing the overall morbidity and mortality significantly. This framework encompasses the collaboration of emergency services, designated Major Trauma Centres (MTCs), Trauma Units (TUs) and community providers which have been optimized with the expertise and resources to provide the best outcomes for major trauma patients. Specific triage protocols, consultant-led trauma service and on-the-spot access to radiology services and operating theatres have played a pivotal role in the improvement of trauma care. In spite of several strengths, however, the London major trauma network system is by no means without its limitations. The emergence of the new coronavirus disease 2019 (COVID-19) pandemic has created major barriers to the smooth running of trauma services by exhausting resources due to infection control measures, reduced theatre space and re-deployment of medical staffs. In addition, the cancellation of elective surgeries has impacted directly on the training of surgical trainees by leaving them with significantly reduced surgical exposure. As a results of this ever changing surgical landscape, a need to urgently review these traditional surgical training methods with a view to modernize the curriculum. Although the London trauma system has evolved significantly since its implementation, its limitations should be recognized and addressed to enhance performance and improve patient outcomes.
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Affiliation(s)
| | - Komal Moqeem
- Internal Medicine, Royal Surrey County Hospital, Guildford, GBR
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41
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Purdy EI, McLean D, Alexander C, Scott M, Donohue A, Campbell D, Wullschleger M, Berkowitz G, Winearls J, Henry D, Brazil V. Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care. BMJ Open Qual 2020; 9:bmjoq-2019-000749. [PMID: 32046977 PMCID: PMC7047507 DOI: 10.1136/bmjoq-2019-000749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/10/2019] [Accepted: 01/22/2020] [Indexed: 11/06/2022] Open
Abstract
Background Trauma care represents a complex patient journey, requiring multidisciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, co-operation and coordination across diverse groups. We aimed to define and improve relational aspects of trauma care at Gold Coast University Hospital. Methods We conducted a mixed-methods collaborative ethnography using the relational coordination survey—an established tool to analyse the relational dimensions of multidisciplinary teamwork—participant observation, interviews and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance. Findings We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation programme in contributing positively to team culture and relational ties. A range of 16 interventions—focusing on structural, process and relational dimensions—were co-created with participants and are now being implemented and evaluated by various trauma care providers. Conclusions Through engagement of clinicians spanning organisational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage healthcare leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.
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Affiliation(s)
- Eve Isabelle Purdy
- Emergency Medicine, Queen's University, Kingston, Ontario, Canada .,Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Darren McLean
- Centre for Health Innovation, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Charlotte Alexander
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Matthew Scott
- Trauma Service, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Andrew Donohue
- Anaesthetics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Don Campbell
- Trauma Service/Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Martin Wullschleger
- Trauma Service/General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Gary Berkowitz
- High Acuity Response Unit, Queensland Ambulance Service, Southport, Queensland, Australia
| | - James Winearls
- Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Doug Henry
- Department of Anthropology, University of North Texas, Denton, Texas, USA
| | - Victoria Brazil
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
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42
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Reliability of the assessment of non-technical skills by using video-recorded trauma resuscitations. Eur J Trauma Emerg Surg 2020; 48:441-447. [PMID: 32617607 PMCID: PMC8825620 DOI: 10.1007/s00068-020-01401-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/16/2020] [Indexed: 02/03/2023]
Abstract
Purpose Non-technical skills have gained attention, since enhancement of these skills is presumed to improve the process of trauma resuscitation. However, the reliability of assessing non-technical skills is underexposed, especially when using video analysis. Therefore, our primary aim was to assess the reliability of the Trauma Non-Technical Skills (T-NOTECHS) tool by video analysis. Secondarily, we investigated to what extent reliability increased when the T-NOTECHS was assessed by three assessors [average intra-class correlation (ICC)] instead of one (individual ICC). Methods As calculated by a pre-study power analysis, 18 videos were reviewed by three research assistants using the T-NOTECHS tool. Average and individual degree of agreement of the assessors was calculated using a two-way mixed model ICC. Results Average ICC was ‘excellent’ for the overall score and all five domains. Individual ICC was classified as ‘excellent’ for the overall score. Of the five domains, only one was classified as ‘excellent’, two as ‘good’ and two were even only ‘fair’. Conclusions Assessment of non-technical skills using the T-NOTECHS is reliable using video analysis and has an excellent reliability for the overall T-NOTECHS score. Assessment by three raters further improve the reliability, resulting in an excellent reliability for all individual domains.
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Hautz SC, Oberholzer DL, Freytag J, Exadaktylos A, Kämmer JE, Sauter TC, Hautz WE. An observational study of self-monitoring in ad hoc health care teams. BMC MEDICAL EDUCATION 2020; 20:201. [PMID: 32576185 PMCID: PMC7313223 DOI: 10.1186/s12909-020-02115-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Working in ad hoc teams in a health care environment is frequent but a challenging and complex undertaking. One way for teams to refine their teamwork could be through post-resuscitation reflection and debriefing. However, this would require that teams have insight into the quality of their teamwork. This study investigates (1) the accuracy of the self-monitoring of ad hoc resuscitation teams and their leaders relative to external observations of their teamwork and (2) the relationship of team self-monitoring and external observations to objective performance measures. METHODS We conducted a quantitative observational study of real-world ad hoc interprofessional teams responding to a simulated cardiac arrest in an emergency room. Teams consisting of residents, consultants, and nurses were confronted with an unexpected, simulated, standardized cardiac arrest situation. Their teamwork was videotaped to allow for subsequent external evaluation on the team emergency assessment measure (TEAM) checklist. In addition, objective performance measures such as time to defibrillation were collected. All participants completed a demographic questionnaire prior to the simulation and a questionnaire tapping their perceptions of teamwork directly after it. RESULTS 22 teams consisting of 115 health care professionals showed highly variable performance. All performance measures intercorrelated significantly, with the exception of team leaders' evaluations of teamwork, which were not related to any other measures. Neither team size nor cumulative experience were correlated with any measures, but teams led by younger leaders performed better than those led by older ones. CONCLUSION Team members seem to have better insight into their team's teamwork than team leaders. As a practical consequence, the decision to debrief and the debriefing itself after a resuscitation should be informed by team members, not just leaders.
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Affiliation(s)
- Stefanie C Hautz
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Daniel L Oberholzer
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Julia Freytag
- Simulated Patient Program, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Juliane E Kämmer
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
- Max Planck Institute for Human Development, Center for Adaptive Rationality (ARC), Lentzeallee 94, 14195, Berlin, Germany
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
- Lernzentrum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland.
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Belhumeur V, Malo C, Nadeau A, Hegg-Deloye S, Gagné AJ, Émond M. Trauma team leaders in Canada: A national survey. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619847338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The availability, composition and activation criteria for trauma teams vary across different health care systems, but little is known about these features in the Canadian health system. The aim of this study is to provide a description of the current trauma team available in Level 1 and 2 centres across Canada. Methods In 2017, using a modified Dillman technique, a survey was sent to 210 health professionals across all Canadian trauma care facilities, including questions that focused on (1) the presence and the composition of a trauma team, (2) the established criteria to activate this team and (3) the initial patient care. Results Overall, 107 (57%) completed surveys were received. Only 22 (11.7%) were from Level 1 or 2 centre and considered for compilation. Seventeen respondents have a trauma team in their centre, and they all shared their criteria for activating their team (1–27 different indications). The suspected injuries, the judgment of the emergency physician, the systolic blood pressure, the Glasgow Coma Score and the respiratory rate were the most frequently mentioned items. In the presence of a pre-hospital care warning, the initial assessment of a severely injured patient is exclusively completed by a member of the trauma team for only 35.1% of the respondents. For 11.8% of respondents, trauma team coordinates airway management. For 64.7% of participants, the trauma team leader is the dedicated care provider to accompany patients until the final destination. Conclusions The results suggest a great variability across Canada, regarding the roles assumed by the trauma team but also regarding the activation criteria leading them to take action.
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Affiliation(s)
| | - Christian Malo
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec City, Canada
| | - Alexandra Nadeau
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Axe Santé des Populations et Pratiques Optimales en santé, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Canada
| | - Sandrine Hegg-Deloye
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Axe Santé des Populations et Pratiques Optimales en santé, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Canada
| | - Anne-Julie Gagné
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Axe Santé des Populations et Pratiques Optimales en santé, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Canada
| | - Marcel Émond
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec City, Canada
- Axe Santé des Populations et Pratiques Optimales en santé, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Canada
- Centre de Recherche sur les Soins et Les Services de Première Ligne de l'Université Laval (CRSSPL-UL), Quebec City, Canada
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Trauma Response Nurse: Bringing Critical Care Experience and Continuity to Early Trauma Care. J Trauma Nurs 2020; 26:215-220. [PMID: 31283751 DOI: 10.1097/jtn.0000000000000454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Multitrauma patients can benefit significantly from specialized care. Prior to mid-2016, this hospital's trauma team did not include a surgical intensive care unit (SICU) nurse. As the value of bringing this expertise to the patient upon arrival was realized, the role of the trauma response nurse (TRN) was developed. The TRN role was designed to provide a dedicated SICU nurse to care for trauma patients from emergency department (ED) arrival through disposition. The integration of the TRN role into the trauma team sought to improve quality and safety, as well as communication and collaboration, and enhance continuity of care. The primary responsibilities of the TRN were to assist with clinical interventions, transport patients fromthe ED to tests and procedures, and assume care through disposition. Additional TRN duties included education, community outreach, and performance improvement. TRNs now respond to all trauma activations that occur on weekday day shift. This role has improved collaboration between nursing disciplines, improved the overall function of the trauma team, and enhanced the safety of trauma patients during transport. TRNs make valuable contributions to the education and outreach missions of the trauma program and ensure that patients are receiving the highest level of trauma care.
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Heard J, Paris RA, Scully D, McNaughton C, Ehrenfeld JM, Coco J, Fabbri D, Bodenheimer B, Adams JA. Automatic Clinical Procedure Detection for Emergency Services. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:337-340. [PMID: 31945910 DOI: 10.1109/embc.2019.8856281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Understanding a patient's state is critical to providing optimal care. However, information loss occurs during patient hand-offs (e.g., emergency services (EMS) transferring patient care to a receiving hospital), which hinders care quality. Augmenting the information flow from an EMS vehicle to a receiving hospital may reduce information loss and improve patient outcomes. Such augmentation requires a noninvasive system that can automatically recognize clinical procedures being performed and send near real-time information to a receiving hospital. An automatic clinical procedure detection system that uses wearable sensors, video, and machine-learning to recognize clinical procedures within a controlled environment is presented. The system demonstrated how contextual information and a majority vote method can substantially improve procedure recognition accuracy. Future work concerning computer vision techniques and deep learning are discussed.
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Abstract
BACKGROUND Nurses working in military trauma teams often work in hostile and remote locations. They are faced with the burden of carrying out their duties while ensuring the safety of their patients and themselves in areas of conflict and humanitarian crisis. The stories and experiences of military nurses often go untold. In a phenomenological study, six Australian Defence Force Nursing Officers share their stories of working as members of military trauma teams. OBJECTIVES The aim of this study was to gain an understanding of the lived experiences of nursing officers when working as a member of a military trauma team. METHODS A hermeneutic phenomenological approach was used to conduct this research. In-depth interviews were conducted with six participants. RESULTS The following themes were identified: telling their stories; the role-who we are and what we do; the environment-it is so different; training-will it ever fully prepare you; working in teams-there's no "I" in team; and leadership-will the real leader please stand up! DISCUSSION This study has provided an insight into the experiences of six Australian military nurses working in trauma teams-experiences that were rarely given voice outside the military. Central to this experience is the need to have these stories told.
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Peng Y, Anton NE, Cha J, Mizota T, Hennings JM, Stambro R, Rendina MA, Stanton-Maxey KJ, Stefanidis D, Yu D. Objective Measures of Communication Behavior Predict Clinical Performance. JOURNAL OF SURGICAL EDUCATION 2019; 76:1337-1347. [PMID: 30956082 DOI: 10.1016/j.jsurg.2019.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/08/2019] [Accepted: 03/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Effective teamwork and communication are critical to patient outcomes, and subjective assessment tools have been studied in predicting team performances. However, inherent biases remain while using subjective assessment tools. This study hypothesizes that objective communication features can assess and predict clinical performance. DESIGN Forty 3rd-year medical students participated in the Acute Care Trauma Simulation as the role of doctor, teaming up with a nurse confederate and a simulated patient. Participants conducted postoperative patient management, patient care diagnoses, and treatment. Audio from all team members were recorded, speech variables (e.g., speech duration, number of conversations, etc.) were extracted, and statistical analyses were performed to associate communication with clinical performance. SETTING This study was performed at the simulation center located at Fairbanks Hall, Indiana University School of Medicine. PARTICIPANTS Data from forty 3rd-year medical students were collected and analyzed. RESULTS Majority (67%) of the communications were initiated by student. Speech ratio, intensity, and frequency of communications differed when students communicate with nurse than with patient (e.g., student communication to patient had higher intensity than nurse). Increasing frequency of check-backs between student and nurse (p < 0.05) and speech duration from student to patient (p = 0.001) positively associated with student's clinical performance score. CONCLUSION Objective communication features can predict medical trainee's clinical performance and provide an objective approach for simulation-based trauma care training.
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Affiliation(s)
- Yuhao Peng
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana
| | - Nicholas E Anton
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jackie Cha
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana
| | - Tomoko Mizota
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Julie M Hennings
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ryan Stambro
- Simulation Center at Fairbanks Hall, Indiana University Health, Indianapolis, Indiana
| | - Megan A Rendina
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana.
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Ono Y, Kakamu T, Ishida T, Sasaki T, Inoue S, Kotani J, Shinohara K. Impact of the academic calendar cycle on survival outcome of injured patients: a retrospective cohort study at a community emergency department in Japan. J Intensive Care 2019; 7:39. [PMID: 31388430 PMCID: PMC6669975 DOI: 10.1186/s40560-019-0395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Commencement of a new academic cycle is presumed to be associated with poor patient outcomes. However, supportive evidence is limited for trauma patients treated in under-resourced hospitals, especially those who require specialized interventions and with little physiological reserve. We examined whether a new academic cycle affects the survival outcomes of injured patients in a typical Japanese teaching hospital. Methods This historical cohort study was conducted at a Japanese community emergency department (ED). All injured patients brought to the ED from April 2002 to March 2018 were included in the analysis. The primary exposure was presentation to the ED during the first quartile of the academic cycle (April-June). The primary outcome measure was the hospital mortality rate. Results Of the 20,945 eligible patients, 5282 (25.2%) were admitted during the first quartile. In the univariable analysis, the hospital mortality rate was similar between patients admitted during the first quartile of the academic year and those admitted during the remaining quartiles (4.1% vs. 4.4%, respectively; odds ratio [OR], 0.931; 95% confidence interval [CI] 0.796-1.088). After adjusting for the potential confounding factors of the injury severity score, age, sex, Glasgow coma scale score, systolic blood pressure, trauma etiology (blunt or penetrating), and admission phase (2002-2005, 2006-2009, 2010-2013, and 2014-2018), no statistically significant association was present between first-quartile admission and trauma death (adjusted OR 0.980; 95% CI 0.748-1.284). Likewise, when patients were subgrouped according to age of > 55 years, injury severity score of > 15, Glasgow coma scale score of < 9, systolic blood pressure of < 90 mmHg, requirement for doctor car system dispatches, emergency operation, emergency endotracheal intubation, and weekend and night presentation, no significant associations were present between first-quartile admission and hospital mortality in both the univariable and multivariable analysis. Conclusions At a community hospital in Japan, admission at the beginning of the academic year was not associated with an increased risk of hospital mortality among trauma patients, even those requiring specialized interventions and with little physiological reserve. Our results support the uniformity of trauma care provision throughout the academic cycle in a typical Japanese trauma system.
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Affiliation(s)
- Yuko Ono
- 1Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima 963-8558 Japan.,2Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017 Japan
| | - Takeyasu Kakamu
- 3Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295 Japan
| | - Tokiya Ishida
- 1Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima 963-8558 Japan
| | - Tetsu Sasaki
- 1Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima 963-8558 Japan
| | - Shigeaki Inoue
- 2Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017 Japan
| | - Joji Kotani
- 2Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017 Japan
| | - Kazuaki Shinohara
- 1Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima 963-8558 Japan
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van Maarseveen OEC, Ham WHW, van de Ven NLM, Saris TFF, Leenen LPH. Effects of the application of a checklist during trauma resuscitations on ATLS adherence, team performance, and patient-related outcomes: a systematic review. Eur J Trauma Emerg Surg 2019; 46:65-72. [PMID: 31392359 PMCID: PMC7026213 DOI: 10.1007/s00068-019-01181-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE In this systematic literature review, the effects of the application of a checklist during in hospital resuscitation of trauma patients on adherence to the ATLS guidelines, trauma team performance, and patient-related outcomes were integrated. METHODS A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist. The search was performed in Pubmed, Embase, CINAHL, and Cochrane inception till January 2019. Randomized controlled- or controlled before-and-after study design were included. All other forms of observational study designs, reviews, case series or case reports, animal studies, and simulation studies were excluded. The Effective Public Health Practice Project Quality Assessment Tool was applied to assess the methodological quality of the included studies. RESULTS Three of the 625 identified articles were included, which all used a before-and-after study design. Two studies showed that Advanced Trauma Life Support (ATLS)-related tasks are significantly more frequently performed when a checklist was applied during resuscitation. [14 of 30 tasks (p < 0.05), respectively, 18 of 19 tasks (p < 0.05)]. One study showed that time to task completion (- 9 s, 95% CI = - 13.8 to - 4.8 s) and workflow improved, which was analyzed as model fitness (0.90 vs 0.96; p < 0.001); conformance frequency (26.1% vs 77.6%; p < 0.001); and frequency of unique workflow traces (31.7% vs 19.1%; p = 0.005). One study showed that the incidence of pneumonia was higher in the group where a checklist was applied [adjusted odds ratio (aOR) 1.69, 95% Confidence Interval (CI 1.03-2.80)]. No difference was found for nine other assessed complications or missed injuries. Reduced mortality rates were found in the most severely injured patient group (Injury Severity score > 25, aOR 0.51, 95% CI 0.30-0.89). CONCLUSIONS The application of a checklist may improve ATLS adherence and workflow during trauma resuscitation. Current literature is insufficient to truly define the effect of the application of a checklist during trauma resuscitation on patient-related outcomes, although one study showed promising results as an improved chance of survival for the most severely injured patients was found.
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Affiliation(s)
- Oscar E C van Maarseveen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Wietske H W Ham
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Institute of Nursing Studies, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands
| | - Nils L M van de Ven
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Tim F F Saris
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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