1
|
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.
Collapse
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
| |
Collapse
|
2
|
Trauma Quality Improvement and Team Education: How Can We Better Optimize Our Training? CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
|
3
|
Fitzgerald MC, Noonan M, Lim E, Mathew JK, Boo E, Stergiou HE, Kim Y, Reilly S, Groombridge C, Maini A, Williams K, Mitra B. Multi-disciplinary, simulation-based, standardised trauma team training within the Victorian State Trauma System. Emerg Med Australas 2023; 35:62-68. [PMID: 36052421 PMCID: PMC10087482 DOI: 10.1111/1742-6723.14068] [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: 09/02/2021] [Revised: 04/26/2022] [Accepted: 07/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Inconsistency in the structure and function of team-based major trauma reception and resuscitation is common. A standardised trauma team training programme was initiated to improve quality and consistency among trauma teams across a large, mature trauma system. The aim of this manuscript is to outline the programme and report on the initial perception of participants. METHODS The Alfred Trauma Team Reception and Resuscitation Training (TTRRT) programme commenced in March 2019. Participants included critical care and surgical craft group members commonly involved in trauma teams. Training was site-specific and included rural, urban and tertiary referral centres. The programme consisted of prescribed pre-learning, didactic lectures, skill stations and simulated team-based scenarios. Participant perceptions of the programme were collected before and after the programme for analysis. RESULTS The TTRRT was delivered to 252 participants and 120 responses were received. Significant improvement in participant-reported confidence was identified across all key topic areas. There was also a significant increase in both confidence and clinical exposure to trauma team leadership roles after participation in the programme (from 53 [44.2%] to 74 [61.7%; P = 0.007]). This finding was independent of clinician experience. CONCLUSIONS A team-based trauma reception and resuscitation education programme, introduced in a large, mature trauma system led to positive participant-reported outcomes in clinical confidence and real-life team leadership participation. Wider implementation combined with longitudinal data collection will facilitate correlation with patient and staff-centred outcomes.
Collapse
Affiliation(s)
- Mark C Fitzgerald
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michael Noonan
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emma Lim
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Joseph K Mathew
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ellaine Boo
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Helen E Stergiou
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Yesul Kim
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Stephanie Reilly
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Christopher Groombridge
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Amit Maini
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kim Williams
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Rosenman ED, Misisco A, Olenick J, Brolliar SM, Chipman AK, Vrablik MC, Chao GT, Kozlowski SWJ, Grand JA, Fernandez R. Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations. J Am Coll Emerg Physicians Open 2021; 2:e12348. [PMID: 33532754 PMCID: PMC7823088 DOI: 10.1002/emp2.12348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/24/2020] [Accepted: 12/11/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Team leadership facilitates teamwork and is important to patient care. It is unknown whether physician gender-based differences in team leadership exist. The objective of this study was to assess and compare team leadership and patient care in trauma resuscitations led by male and female physicians. METHODS We performed a secondary analysis of data from a larger randomized controlled trial using video recordings of emergency department trauma resuscitations at a Level 1 trauma center from April 2016 to December 2017. Subjects included emergency medicine and surgery residents functioning as trauma team leaders. Eligible resuscitations included adult patients meeting institutional trauma activation criteria. Two video-recorded observations for each participant were coded for team leadership quality and patient care by 2 sets of raters. Raters were balanced with regard to gender and were blinded to study hypotheses. We used Bayesian regression to determine whether our data supported gender-based advantages in team leadership. RESULTS A total of 60 participants and 120 video recorded observations were included. The modal relationship between gender and team leadership (β = 0.94, 95% highest density interval [HDI], -.68 to 2.52) and gender and patient care (β = 2.42, 95% HDI, -2.03 to 6.78) revealed a weak positive effect for female leaders on both outcomes. Gender-based advantages to team leadership and clinical care were not conclusively supported or refuted, with the exception of rejecting a strong male advantage to team leadership. CONCLUSIONS We prospectively measured team leadership and clinical care during patient care. Our findings do not support differences in trauma resuscitation team leadership or clinical care based on the gender of the team leader.
Collapse
Affiliation(s)
| | - Anthony Misisco
- Department of PsychologyMichigan State UniversityEast LansingMichiganUSA
| | - Jeffrey Olenick
- Department of PsychologyMichigan State UniversityEast LansingMichiganUSA
- Department of PsychologyOld Dominion UniversityNorfolkVirginia
| | - Sarah M. Brolliar
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Anne K. Chipman
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Marie C. Vrablik
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Georgia T. Chao
- Department of PsychologyMichigan State UniversityEast LansingMichiganUSA
- Department of PsychologyUniversity of South FloridaTampaFlorida
| | - Steve W. J. Kozlowski
- Department of PsychologyMichigan State UniversityEast LansingMichiganUSA
- Department of PsychologyUniversity of South FloridaTampaFlorida
| | - James A. Grand
- Department of PsychologyUniversity of MarylandCollege ParkMarylandUSA
| | | |
Collapse
|
5
|
Hulfish E, Diaz MCG, Feick M, Messina C, Stryjewski G. The Impact of a Displayed Checklist on Simulated Pediatric Trauma Resuscitations. Pediatr Emerg Care 2021; 37:23-28. [PMID: 29489608 DOI: 10.1097/pec.0000000000001439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Advanced Trauma Life Support resuscitation follows a strict protocolized approach to the initial trauma evaluation. Despite this structure, elements of the primary and secondary assessments can still be omitted. The aim of this study is to determine if a cognitive aid checklist reduces omissions and speeds the time to assessment completion. We additionally investigated if a displayed checklist improved performance further. METHODS A series of 131 simulated trauma resuscitations were performed. Teams were randomized to 1 of 3 arms (no checklist, handheld checklist, or displayed). The scenarios were recorded and analyzed to determine time to completion and absolute completion of tasks of the primary and secondary survey. The workload of individual team members was assessed via NASA-TLX. RESULTS There was no difference in time to completion of surveys among the 3 arms. In the primary survey, there was a nonsignificant increase in the number of completed tasks with the use of the displayed checklist. In the secondary survey, there was a significant improvement in task completion with the displayed checklists with improved evaluation of the pelvis (P = 0.011), lower extremities (P = 0.048), and covering the patient (P = 0.046). There was a significant improvement in performance in those reported among nurse documenters with use of the displayed checklist. CONCLUSIONS Despite a structured approach to trauma resuscitations, omissions still occur. The use of a displayed checklist improves performance and reduces omissions without delaying assessment. Better compliance with Advanced Trauma Life Support protocols may improve patient outcomes.
Collapse
Affiliation(s)
- Erin Hulfish
- From the Stony Brook Children's Hospital, Stony Brook University, Stony Brook, NY
| | - Maria Carmen G Diaz
- Nemours/AI duPont Hospital for Children, Thomas Jefferson University, Wilmington, DE
| | - Megan Feick
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Catherine Messina
- Deparment of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Glenn Stryjewski
- Inpatient Medical Director, Pediatric Intensive Care Unit, Alaska Native Medical Center, Anchorage, AK
| |
Collapse
|
6
|
Wilson S, Rixon A, Hartanto S, White P, Judkins S. Review article: Systematic literature review of leadership in emergency departments. Emerg Med Australas 2020; 32:935-952. [PMID: 33089650 DOI: 10.1111/1742-6723.13658] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 01/04/2023]
Abstract
Emergency medicine (EM) is a discipline with complex leadership demands. However, studies of EM physician leadership and ED leadership are in their infancy. As such, there is a lack of clarity about the forms, antecedents, enablers, barriers and consequences of EM physician leadership. A systematic review of the scientific literature was conducted to reveal the different conceptualisations of EM physician leadership, the activities involved in the practice of leadership, and the knowledge and skills of effective ED leaders. Seven databases were systematically searched for peer-reviewed empirical studies on the topic of EM physicians carrying out a manager or leadership role in an ED setting. Finally, 26 articles were included, and their findings were synthesised and analysed narratively. Two conceptualisations of EM physician leadership were found, reflecting clinical leadership and medical leadership, respectively. Clinical leadership is performed by all EM physicians, often informally, within their daily clinical practice, whereas medical leadership is performed by EM physicians who work at the management level within a hospital, in addition to or instead of their clinical practice. The focus of EM physician leadership and ED leadership research is team leadership, with much less attention given to wider organisation leadership. Consistent with the focus on team leadership, clinical knowledge and skill in orchestrating teams, especially trauma and resuscitation teams, emerged as the most important factors underpinning leadership effectiveness. Future research and training should make better use of existing leadership theory and research designs to illuminate the forms, dynamics, antecedents, moderators and consequences of EM physician leadership.
Collapse
Affiliation(s)
- Samuel Wilson
- Department of Management and Marketing, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Andrew Rixon
- Department of Business Technology and Entrepreneurship, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Stephanie Hartanto
- Department of Business Technology and Entrepreneurship, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Peter White
- Australasian College for Emergency Medicine, Melbourne, Victoria, Australia
| | - Simon Judkins
- Australasian College for Emergency Medicine, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
The Effect of a Multidisciplinary Trauma Team Leader Paradigm at a Tertiary Trauma Center: 10-Year Experience. Emerg Med Int 2020; 2020:8412179. [PMID: 32855826 PMCID: PMC7443032 DOI: 10.1155/2020/8412179] [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: 11/26/2019] [Revised: 04/23/2020] [Accepted: 05/23/2020] [Indexed: 11/18/2022] Open
Abstract
Background To illustrate the impact of the implementation of a multidisciplinary TTL program in 2005 on the mortality of trauma patients in a level 1 trauma center as well as admission rates and length of stay. Methods Retrospective observational study of all trauma patients included in the provincial trauma database at the Montreal General Hospital between 1998 and 2015. The primary outcome studied was in-hospital mortality. The secondary outcomes studied were hospital and intensive care unit (ICU) rates of admission and hospital and ICU length of stay. Results 24,107 patients were included. We observed a statistically significant reduction in mortality of 1.25% or a relative reduction of 16% (p value = 0.0058; rate ratio 0.844 (95% CI 0.747-0.952)). ICU admissions were also significantly reduced where we observed a statistically significant absolute reduction of 4.46% or a relative reduction of 14% (p value = 8.38 × 10-7; rate ratio 0.859 (95% CI 0.808-0.912)). The ICU length of stay was increased by 0.91 days or 19.03% (p value = 0.016 (95% CI 0.167-1.655)). There was no observed change in overall length of stay (13.97 days pre-TTL and 12.91 post-TTL (p value = 0.13; estimate -1.053 (95% CI -2.424-0.318))). Conclusions This article suggests that multidisciplinary TTL model may be beneficial in the care of trauma patients. Further subgroup analysis may help determine which patients could benefit more.
Collapse
|
8
|
Simulation-Based Team Leadership Training Improves Team Leadership During Actual Trauma Resuscitations: A Randomized Controlled Trial. Crit Care Med 2020; 48:73-82. [PMID: 31725441 DOI: 10.1097/ccm.0000000000004077] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Trauma resuscitations are complex critical care events that present patient safety-related risk. Simulation-based leadership training is thought to improve trauma care; however, there is no robust evidence supporting the impact of leadership training on clinical performance. The objective of this study was to assess the clinical impact of simulation-based leadership training on team leadership and patient care during actual trauma resuscitations. DESIGN Randomized controlled trial. SETTING Harborview Medical Center (level 1 trauma center). SUBJECTS Seventy-nine second- and third-year residents were randomized and 360 resuscitations were analyzed. INTERVENTIONS Subjects were randomized to a 4-hour simulation-based leadership training (intervention) or standard orientation (control) condition. MEASUREMENTS AND MAIN RESULTS Participant-led actual trauma resuscitations were video recorded and coded for leadership behaviors and patient care. We used random coefficient modeling to account for the nesting effect of multiple observations within residents and to test for post-training group differences in leadership behaviors while controlling for pre-training behaviors, Injury Severity Score, postgraduate training year, and days since training occurred. Sixty participants completed the study. There was a significant difference in post-training leadership behaviors between the intervention and control conditions (b1 = 4.06, t (55) = 6.11, p < 0.001; intervention M = 11.29, SE = 0.66, 95% CI, 9.99-12.59 vs control M = 7.23, SE = 0.46, 95% CI, 6.33-8.13, d = 0.92). Although patient care was similar between conditions (b = 2.00, t (55) = 0.99, p = 0.325; predicted means intervention M = 62.38, SE = 2.01, 95% CI, 58.43-66.33 vs control M = 60.38, SE = 1.37, 95% CI, 57.69-63.07, d = 0.15), a test of the mediation effect between training and patient care suggests leadership behaviors mediate an effect of training on patient care with a significant indirect effect (b = 3.44, 95% CI, 1.43-5.80). Across all trauma resuscitations leadership was significantly related to patient care (b1 = 0.61, SE = 0.15, t (273) = 3.64, p < 0.001). CONCLUSIONS Leadership training resulted in the transfer of complex skills to the clinical environment and may have an indirect effect on patient care through better team leadership.
Collapse
|
9
|
Kim OH, Go SJ, Kwon OS, Park CY, Yu B, Chang SW, Jung PY, Lee GJ. Part 2. Clinical Practice Guideline for Trauma Team Composition and Trauma Cardiopulmonary Resuscitation from the Korean Society of Traumatology. JOURNAL OF TRAUMA AND INJURY 2020. [DOI: 10.20408/jti.2020.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
10
|
Fernandez R, Rosenman ED, Brolliar S, Chipman AK, Kalynych C, Vrablik MC, Keebler JR, Lazzara EH. An Event-based Approach to Measurement: Facilitating Observational Measurement in Highly Variable Clinical Settings. AEM EDUCATION AND TRAINING 2020; 4:147-153. [PMID: 32313861 PMCID: PMC7163198 DOI: 10.1002/aet2.10395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Translational research in medical education requires the ability to rigorously measure learner performance in actual clinical settings; however, current measurement systems cannot accommodate the variability inherent in many patient care environments. This is especially problematic in emergency medicine, where patients represent a wide spectrum of severity for a single clinical presentation. Our objective is to describe and implement EBAM, an event-based approach to measurement that can be applied to actual emergency medicine clinical events. METHODS We used a four-step event-based approach to create an emergency department trauma resuscitation patient care measure. We applied the measure to a database of 360 actual trauma resuscitations recorded in a Level I trauma center using trained raters. A subset (n = 50) of videos was independently rated in duplicate to determine inter-rater reliability. Descriptive analyses were performed to describe characteristics of resuscitation events and Cohen's kappa was used to calculate reliability. RESULTS The methodology created a metric containing both universal items that are applied to all trauma resuscitation events and conditional items that only apply in certain situations. For clinical trauma events, injury severity scores ranged from 1 to 75 with a mean (±SD) of 21 (±15) and included both blunt (254/360; 74%) and penetrating (86/360; 25%) traumatic injuries, demonstrating the diverse nature of the clinical encounters. The mean (±SD) Cohen's kappa for patient care items was 0.7 (±0.3). CONCLUSION We present an event-based approach to performance assessment that may address a major gap in translational education research. Our work centered on assessment of patient care behaviors during trauma resuscitation. More work is needed to evaluate this approach across a diverse array of clinical events.
Collapse
Affiliation(s)
- Rosemarie Fernandez
- Department of Emergency Medicine and the Center for Experiential Learning and Simulation, College of MedicineUniversity of FloridaGainesvilleFL
| | | | - Sarah Brolliar
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
| | - Anne K. Chipman
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
| | - Colleen Kalynych
- Department of Emergency Medicine, Office of Educational AffairsUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFL
| | - Marie C. Vrablik
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
| | - Joseph R. Keebler
- Department of Human Factors and Behavioral Neurobiology, College of Arts and SciencesEmbry‐Riddle Aeronautical UniversityDaytona BeachFL
| | - Elizabeth H. Lazzara
- Department of Human Factors and Behavioral Neurobiology, College of Arts and SciencesEmbry‐Riddle Aeronautical UniversityDaytona BeachFL
| |
Collapse
|
11
|
Dumas RP, Vella MA, Chreiman KC, Smith BP, Subramanian M, Maher Z, Seamon MJ, Holena DN. Team Assessment and Decision Making Is Associated With Outcomes: A Trauma Video Review Analysis. J Surg Res 2019; 246:544-549. [PMID: 31635832 DOI: 10.1016/j.jss.2019.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/24/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Teamwork is a critical element of trauma resuscitation. Assessment tools such as T-NOTECHS (Trauma NOn-TECHnical Skills) exist, but correlation with patient outcomes is unclear. Using emergency department thoracotomy (EDT), we sought to describe T-NOTECHS scores during resuscitations. We hypothesized that patients undergoing EDT whose resuscitations had better scores would be more likely to have return of spontaneous circulation (ROSC). METHODS Continuously recording video was used to review all captured EDTs over a 24-mo period. We used a modification of the validated T-NOTECHS instrument to measure five domains on a 3-point scale (1 = best, 2 = average, 3 = worst). A total T-NOTECHS score was calculated by one of three reviewers. The primary outcome was ROSC. ROSC was defined as an organized rhythm no longer requiring internal cardiac compressions. Associations between variables and ROSC were examined using univariate regression. RESULTS Sixty-one EDTs were captured. Nineteen patients had ROSC (31%) and 42 (69%) did not. The median T-NOTECHS score for all resuscitations was 8 [IQR 6-10]. As demographic and injury data (age, gender, mechanism, signs of life) were not associated with ROSC in univariate analysis, they were not considered for inclusion in a multivariable regression model. The association between overall T-NOTECHS score and ROSC did not reach statistical significance, but examination of the individual components of the T-NOTECHS score demonstrated that, compared to resuscitations that had "average" (2) or "worst" (3) scores on "Assessment and Decision Making," resuscitations with a "best" score were 5 times more likely to lead to ROSC. CONCLUSIONS Although the association between overall T-NOTECHS scores and ROSC did not reach statistical significance, better scores in the domain of assessment and decision making are associated with improved rates of ROSC in patients arriving in cardiac arrest who undergo EDT. LEVEL OF EVIDENCE Level IV Therapeutic/Care Management.
Collapse
Affiliation(s)
- Ryan P Dumas
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Michael A Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen C Chreiman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P Smith
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madhu Subramanian
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zoe Maher
- Division of Trauma and Surgical Critical Care, Temple University, Philadelphia, Pennsylvania
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel N Holena
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
12
|
Noonan M, Olaussen A, Mathew J, Mitra B, Smit DV, Fitzgerald M. What Is the Clinical Evidence Supporting Trauma Team Training (TTT): A Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2019; 55:medicina55090551. [PMID: 31480360 PMCID: PMC6780651 DOI: 10.3390/medicina55090551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 02/03/2023]
Abstract
Background and Objectives: Major trauma centres manage severely injured patients using multi-disciplinary teams but the evidence-base that targeted Trauma Team Training (TTT) improves patients’ outcomes is unclear. This systematic review aimed to identify the association between the implementation of TTT programs and patient outcomes. Materials and Methods: We searched OVID Medline, PubMed and The Cochrane Library (CENTRAL) from the date of the database commencement until 10 of April 2019 for a combination of Medical Subject Headings (MeSH) terms and keywords relating to TTT and clinical outcomes. Reference lists of appraised studies were also screened for relevant articles. We extracted data on the study setting, type and details about the learners, as well as clinical outcomes of mortality and/or time to critical interventions. A meta-analysis of the association between TTT and mortality was conducted using a random effects model. Results: The search yielded 1136 unique records and abstracts, of which 18 full texts were reviewed. Nine studies met final inclusion, of which seven were included in a meta-analysis of the primary outcome. There were no randomised controlled trials. TTT was not associated with mortality (Pooled overall odds ratio (OR) 0.83; 95% Confidence Interval; 0.64–1.09). TTT was associated with improvements in time to operating theatre and time to first computerized tomography (CT) scanning. Conclusions: Despite few publications related to TTT, its introduction was associated with improvements in time to critical interventions. Whether such improvements can translate to improvements in patient outcomes remains unknown. Further research focusing on the translation of standardised trauma team reception “actions” into TTT is required to assess the association between TTT and patient outcome.
Collapse
Affiliation(s)
- Michael Noonan
- National Trauma Research Institute, Melbourne 3004, Australia
- Trauma Service, The Alfred Hospital, Melbourne 3004, Australia
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne 3004, Australia
| | - Alexander Olaussen
- National Trauma Research Institute, Melbourne 3004, Australia
- Department of Community Emergency Health and Paramedic Practice (DCEHPP), Monash University, Melbourne 3199, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Joseph Mathew
- National Trauma Research Institute, Melbourne 3004, Australia
- Trauma Service, The Alfred Hospital, Melbourne 3004, Australia
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne 3004, Australia
| | - Biswadev Mitra
- National Trauma Research Institute, Melbourne 3004, Australia.
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne 3004, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia.
| | - De Villiers Smit
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Mark Fitzgerald
- National Trauma Research Institute, Melbourne 3004, Australia
- Trauma Service, The Alfred Hospital, Melbourne 3004, Australia
| |
Collapse
|
13
|
Madani A, Gips A, Razek T, Deckelbaum DL, Mulder DS, Grushka JR. Defining and Measuring Decision-Making for the Management of Trauma Patients. JOURNAL OF SURGICAL EDUCATION 2018; 75:358-369. [PMID: 28756147 DOI: 10.1016/j.jsurg.2017.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/23/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Effective management of trauma patients is heavily dependent on sound judgment and decision-making. Yet, current methods for training and assessing these advanced cognitive skills are subjective, lack standardization, and are prone to error. This qualitative study aims to define and characterize the cognitive and interpersonal competencies required to optimally manage injured patients. METHODS Cognitive and hierarchical task analyses for managing unstable trauma patients were performed using qualitative methods to map the thoughts, behaviors, and practices that characterize expert performance. Trauma team leaders and board-certified trauma surgeons participated in semistructured interviews that were transcribed verbatim. Data were supplemented with content from published literature and prospectively collected field notes from observations of the trauma team during trauma activations. The data were coded and analyzed using grounded theory by 2 independent reviewers. RESULTS A framework was created based on 14 interviews with experts (lasting 1-2 hours each), 35 field observations (20 [57%] blunt; 15 [43%] penetrating; median Injury Severity Score 20 [13-25]), and 15 literary sources. Experts included 11 trauma surgeons and 3 emergency physicians from 7 Level 1 academic institutions in North America (median years in practice: 12 [8-17]). Twenty-nine competencies were identified, including 17 (59%) related to situation awareness, 6 (21%) involving decision-making, and 6 (21%) requiring interpersonal skills. Of 40 potential errors that were identified, root causes were mapped to errors in situation awareness (20 [50%]), decision-making (10 [25%]), or interpersonal skills (10 [25%]). CONCLUSIONS This study defines cognitive and interpersonal competencies that are essential for the management of trauma patients. This framework may serve as the basis for novel curricula to train and assess decision-making skills, and to develop quality-control metrics to improve team and individual performance.
Collapse
Affiliation(s)
- Amin Madani
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Amanda Gips
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tarek Razek
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan L Deckelbaum
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - David S Mulder
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jeremy R Grushka
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
14
|
Lapierre A, Gauvin-Lepage J, Lefebvre H. La collaboration interprofessionnelle lors de la prise en charge d’un polytraumatisé aux urgences : une revue de la littérature. Rech Soins Infirm 2017:73-88. [DOI: 10.3917/rsi.129.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
15
|
Cho WT, Cho JW, Kim J, Kim JK, Oh JK, Kim HJ, Kim N, Cho JM. The Effect of Trauma Team Approach on the Management of Hemodynamically Unstable Pelvic Bone Fracture: Retrospective Comparative study. JOURNAL OF TRAUMA AND INJURY 2016. [DOI: 10.20408/jti.2016.29.4.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Won-Tae Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jinil Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jin-Kak Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Hak Jun Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Namryeol Kim
- General Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jun-Min Cho
- General Surgery, Korea University Guro Hospital, Seoul, Korea
| |
Collapse
|
16
|
Haake BK, Xiao Y, Mackenzie C, Seagull FJ, Grissom T, Sisley A, Dutton R. Development of an Instrument for Assessing Trauma Team Performance. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/154193120705101116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Teamwork training is critical for patient safety and has been advocated for widespread application in many settings. A key challenge for evaluating teamwork training is measurement. Despite much effort, the team performance instruments reported thus far suffer from a variety shortcomings that prevent their wide application in assessing teams in real settings. Based on review of video recorded trauma team activities in real patient care, a multi-disciplinary research team developed an instrument based on observable behaviors (UMTOP). A set of video clips were reviewed by 6 subject matter experts who were requested to provide “descriptors” about the observed team activities. The 167 collated descriptors were combined to a reduced list, which was then sent to the subject matter experts for revision. The revised list was then categorized into 5 areas of team performance (task and clinical performance, leadership organization, teamwork organization, social environment, sterile precaution). UMTOP was developed to be a tradeoff among four criteria: ease of use, reliability, usefulness for team performance feedback, and speed of scoring. An initial assessment of reliability was conducted with surgeon and nursing reviewers.
Collapse
Affiliation(s)
| | - Yan Xiao
- University of Maryland School of Medicine Baltimore, Maryland
| | - Colin Mackenzie
- University of Maryland School of Medicine Baltimore, Maryland
| | | | - Thomas Grissom
- University of Maryland School of Medicine Baltimore, Maryland
| | - Amy Sisley
- University of Maryland School of Medicine Baltimore, Maryland
| | - Richard Dutton
- University of Maryland School of Medicine Baltimore, Maryland
| |
Collapse
|
17
|
Nassar A, Coates A, Tuma F, Farrokhyar F, Reid S. The MacTRAUMA TTL Assessment Tool: Developing a Novel Tool for Assessing Performance of Trauma Trainees: Initial Reliability Testing. JOURNAL OF SURGICAL EDUCATION 2016; 73:1046-1051. [PMID: 27687539 DOI: 10.1016/j.jsurg.2016.05.013] [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: 02/26/2016] [Revised: 05/02/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To develop a novel assessment tool for trainees-led trauma resuscitation. Assess psychometric properties of the proposed tool. Evaluate feasibility and utility of the tool. INTRODUCTION Trauma resuscitation is a structured and complex process involving unique sets of skills. There is currently no published structured formative evaluation tool for trauma trainees. Therefore, many trauma trainees rely upon limited, unstructured feedback on their performance. We developed a tool to assess trainee performance while leading a trauma resuscitation and to assist faculty in providing trainee feedback after the encounter. METHODS This study was conducted in a level I trauma centre in Ontario, Canada. Principles of learning theories, literature review, and clinical expert opinions were used to design a tool to assess clinical competence required to lead the resuscitation. In total, 5 critical domains were identified. High-fidelity simulation-based environment was used to test interrater reliability using intraclass correlation coefficients. To gauge feasibility, practicality, and utility of the tool, an online survey was sent to raters and trainees at the end of the study. RESULTS We found "excellent" agreement for "initial critical assessment" domain (0.80) and "moderate to good" agreement for the "communication and leadership" (0.67) and "clinical performance" domains (0.53). "Poor" agreement was identified for the "decision-making" domain (0.33). The coefficients for individual items reached "good" agreement for 5 items, and "moderate" agreement for 8 items. Intraclass correlation coefficients for the remaining 7 items were "fair" or "poor." Most raters agreed that items in the medical training domain were not applicable. Feedback from raters and trainees confirmed the feasibility and acceptability of the tool for formative feedback, in addition to some suggestions to enhance the tool. CONCLUSION MacTrauma TTL assessment tool is a novel tool for formative feedback for trainees' performance during trauma resuscitation. Initial psychometric property testing is promising. Further reliability and validity testing of the modified tool is needed. The tool has been shown to be feasible and acceptable by both trainees and faculty as a formative assessment tool.
Collapse
Affiliation(s)
- Aussama Nassar
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Angela Coates
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Trauma Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Faiz Tuma
- Oklahoma University College of Medicine, Tulsa, Oklahoma
| | | | - Susan Reid
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
18
|
Abstract
BACKGROUND The role of the surveyor in trauma resuscitations is to identify life-threatening injuries and is meant to be conducted by a set protocol for every patient. Optimal performance of the trauma survey is known to be a challenge in pediatric trauma resuscitation. A postulated reason for this observation is that many trainees, such as pediatric residents, who perform the trauma survey have minimal experience and do not have formal advanced trauma life support training. The assessment of factors that may be obstacles in performing the trauma survey has not been studied robustly. OBJECTIVE The objective of this retrospective cohort study was to use video review of resuscitation of real-life traumatically injured children to (1) describe the characteristics of the trauma patient, the surveyor, and the trauma response team in its current state of function at a tertiary level I trauma center, (2) describe current performance of primary and secondary surveys, as measured by an assessment tool, and (3) determine whether there are specific characteristics associated with reduced quality, completeness, or timeliness of the assessment of an injured child. METHODS Retrospective review of emergency department (ED) trauma activations captured by video recording between June 2009 and January 2012. Video-recorded resuscitations were reviewed, and survey performance was scored using a novel assessment tool applying a scoring system (0, 1, or 2 points) for each essential element (airway, breathing, circulation, etc.) accounting for quality, sequence, and timing of assessments. Maximum score was 8 points for the primary survey and 22 points for the secondary survey. Time to completion of survey elements was recorded. Chart review identified surveyor characteristics (level of training and type of training program) and patient data fields (age, mechanism of injury, trauma level, Glasgow Coma Score, time of encounter, disposition, and number of procedures). Descriptive statistics and univariate analysis were performed. RESULTS Of 749 eligible trauma activations, 228 activations were enrolled in the study with complete data for 202 patients. Most activations met level II criteria and involved blunt trauma. Most patients had a Glasgow Coma Score of 15 and were non-ICU inpatient admissions. PGY-3 residents performed the most surveys (53% of surveys done by residents). Pediatric residents performed 46% of surveys; emergency medicine (EM) residents, 41%; and pediatric EM fellows, 6%. Median scores on primary and secondary surveys were 7 and 12, respectively; median time to completion was 82 seconds and 265 seconds, respectively. Only 22% of primary surveys and 0% of secondary surveys were performed completely. Pediatric EM fellows had the highest mean score on primary and secondary survey. Pediatric EM fellows took longest to perform primary survey and shortest to complete secondary survey. Mean scores on primary and secondary survey were not significantly different between pediatric and EM residents (6.7 vs 6.7; 12.5 vs 11.6). There was no association between survey scores and level or type of training. Emergency medicine residents spent less time on the trauma survey, but this difference did not reach statistical significance. CONCLUSIONS Primary and secondary surveys are frequently performed incompletely and inefficiently regardless of level of training or type of training program. There is no difference in measured performance among different types of residency programs. The impact of trauma resuscitation education on improved survey performance should be studied prospectively.
Collapse
|
19
|
Calleja P, Aitken L, Cooke M. Staff perceptions of best practice for information transfer about multitrauma patients on discharge from the emergency department: a focus group study. J Clin Nurs 2016; 25:2863-73. [DOI: 10.1111/jocn.13334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Pauline Calleja
- School of Nursing & Midwifery; Griffith University; Brisbane Qld Australia
- Menzies Health Institute Queensland; Brisbane Qld Australia
| | - Leanne Aitken
- School of Nursing & Midwifery; Griffith University; Brisbane Qld Australia
- Menzies Health Institute Queensland; Brisbane Qld Australia
- NHMRC Centre of Research Excellence in Nursing (NCREN); Brisbane Qld Australia
- Intensive Care Unit; Princess Alexandra Hospital; Brisbane Qld Australia
- School of Health Sciences; City University London; UK
| | - Marie Cooke
- School of Nursing & Midwifery; Griffith University; Brisbane Qld Australia
- Menzies Health Institute Queensland; Brisbane Qld Australia
- NHMRC Centre of Research Excellence in Nursing (NCREN); Brisbane Qld Australia
| |
Collapse
|
20
|
Baudin F, Floccard B, Desgranges FP, Courtil-Teyssedre S, De Queiroz M, Richard N, Javouhey E. [Effectiveness of management of children with severe trauma in a pediatric trauma center and in an adult trauma center: A before-after study]. Arch Pediatr 2016; 23:367-72. [PMID: 26904971 DOI: 10.1016/j.arcped.2015.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/03/2015] [Accepted: 12/30/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare management of injured children in an adult trauma center (TC) with competencies in pediatric trauma care (2005-2007) and in a pediatric-only trauma center (2010-2012). STUDY DESIGN A before-after retrospective study. PATIENTS AND METHODS Fifty-nine children between 1 and 15 years of age admitted to the adult TC (2005-2007) were compared to 56 children admitted to the pediatric TC (2010-2012). Epidemiological data, severity scores, early outcome, and care duration in trauma resuscitation before whole-body CT were collected and compared between the two periods. RESULTS This study found no significant differences between the two periods in terms of care duration before the whole-body CT scan (28 min [18-40] vs 26.5 min [21-36], P=0.89) and early mortality (eight children [13.5%] vs ten children [17.8%], P=0.35). CONCLUSION With no differences in early management of injured children demonstrated, this study validates the organization within our pediatric trauma center. The effectiveness of management of children between 1 and 15 years of age with severe trauma seems to be similar in the two contexts.
Collapse
Affiliation(s)
- F Baudin
- Service de réanimation pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, groupement hospitalier EST, 59, boulevard Pinel, 69677 Bron cedex, France.
| | - B Floccard
- Service de réanimation chirurgicale, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - F-P Desgranges
- Service d'anesthésie-réanimation, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, France
| | - S Courtil-Teyssedre
- Service de réanimation pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, groupement hospitalier EST, 59, boulevard Pinel, 69677 Bron cedex, France
| | - M De Queiroz
- Service d'anesthésie-réanimation, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, France
| | - N Richard
- Service de réanimation pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, groupement hospitalier EST, 59, boulevard Pinel, 69677 Bron cedex, France
| | - E Javouhey
- Service de réanimation pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, groupement hospitalier EST, 59, boulevard Pinel, 69677 Bron cedex, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France
| |
Collapse
|
21
|
Görges M, West NC, Christopher NA, Koch JL, Brodie SM, Lowlaavar N, Lauder GR, Ansermino JM. An Ethnographic Observational Study to Evaluate and Optimize the Use of Respiratory Acoustic Monitoring in Children Receiving Postoperative Opioid Infusions. Anesth Analg 2016; 122:1132-40. [PMID: 26745756 DOI: 10.1213/ane.0000000000001127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Respiratory depression in children receiving postoperative opioid infusions is a significant risk because of the interindividual variability in analgesic requirement. Detection of respiratory depression (or apnea) in these children may be improved with the introduction of automated acoustic respiratory rate (RR) monitoring. However, early detection of adverse events must be balanced with the risk of alarm fatigue. Our objective was to evaluate the use of acoustic RR monitoring in children receiving opioid infusions on a postsurgical ward and identify the causes of false alarm and optimal alarm thresholds. METHODS A video ethnographic study was performed using an observational, mixed methods approach. After surgery, an acoustic RR sensor was placed on the participant's neck and attached to a Rad87 monitor. The monitor was networked with paging for alarms. Vital signs data and paging notification logs were obtained from the central monitoring system. Webcam videos of the participant, infusion pump, and Rad87 monitor were recorded, stored on a secure server, and subsequently analyzed by 2 research nurses to identify the cause of the alarm, response, and effectiveness. Alarms occurring within a 90-second window were grouped into a single-alarm response opportunity. RESULTS Data from 49 patients (30 females) with median age 14 (range, 4.4-18.8) years were analyzed. The 896 bedside vital sign threshold alarms resulted in 160 alarm response opportunities (44 low RR, 74 high RR, and 42 low SpO2). In 141 periods (88% of total), for which video was available, 65% of alarms were deemed effective (followed by an alarm-related action within 10 minutes). Nurses were the sole responders in 55% of effective alarms and the patient or parent in 20%. Episodes of desaturation (SpO2 < 90%) were observed in 9 patients: At the time of the SpO2 paging trigger, the RR was >10 bpm in 6 of 9 patients. Based on all RR samples observed, the default alarm thresholds, to serve as a starting point for each patient, would be a low RR of 6 (>10 years of age) and 10 (4-9 years of age). CONCLUSIONS In this study, the use of RR monitoring did not improve the detection of respiratory depression. An RR threshold, which would have been predictive of desaturations, would have resulted in an unacceptably high false alarm rate. Future research using a combination of variables (e.g., SpO2 and RR), or the measurement of tidal volumes, may be needed to improve patient safety in the postoperative ward.
Collapse
Affiliation(s)
- Matthias Görges
- From the Departments of *Electrical and Computer Engineering and †Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada; and ‡Department of Neurosciences and Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Comparative effectiveness of inhospital trauma resuscitation at a French trauma center and matched patients treated in the United States. Ann Surg 2013; 258:178-83. [PMID: 23478519 DOI: 10.1097/sla.0b013e31828226b6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of this paper is to compare mortality outcomes between patients treated at a trauma center in France and matched patients in the United States. BACKGROUND Although trauma systems in France and the United States differ significantly in prehospital and inhospital management, previous comparisons have been challenged by the lack of comparable data. METHODS Coarsened exact matching identified matching patients between a single center trauma database from Lyon, France, and the National Trauma Data Bank (NTDB) of the United States. Moderate to severely injured [injury severity score (ISS) > 8] adult patients (age ≥ 16) presenting alive to level 1 trauma centers from 2002 to 2005 with blunt or penetrating injuries were included. After matching patients, multivariate regression analyses were performed to determine difference in mortality between patients in Lyon and the NTDB. RESULTS A total of 1043 significantly injured patients were presented to the Lyon center. Matching eligible patients with complete records were sought from 219,985 patients in the NTDB. The unadjusted odds of mortality at the Lyon center was 2.5 times higher than that of the NTDB [95% confidence interval (CI) = 2.18-2.98]. However, the Lyon center received patients with higher ISS, lower Glasgow Coma Score (GCS), and lower systolic blood pressure (SBP) (all P < 0.001). After 1:1 matching, 858 patient pairs were produced, and the odds of mortality became equivalent [odds ratio (OR) = 1.3, 95% CI = 0.91-1.73]. Similar results were found in multiple subset analyses. CONCLUSIONS Trauma patients admitted to a single French trauma center had an equal chance of survival compared with similarly injured patients treated at US trauma centers.
Collapse
|
23
|
Fernandez Castelao E, Russo SG, Riethmüller M, Boos M. Effects of team coordination during cardiopulmonary resuscitation: a systematic review of the literature. J Crit Care 2013; 28:504-21. [PMID: 23602030 DOI: 10.1016/j.jcrc.2013.01.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 12/28/2012] [Accepted: 01/01/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this study is to identify and evaluate to what extent the literature on team coordination during cardiopulmonary resuscitation (CPR) empirically confirms its positive effect on clinically relevant medical outcome. MATERIAL AND METHODS A systematic literature search in PubMed, MEDLINE, PsycINFO and CENTRAL databases was performed for articles published in the last 30 years. RESULTS A total of 63 articles were included in the review. Planning, leadership, and communication as the three main interlinked coordination mechanisms were found to have effect on several CPR performance markers. A psychological theory-based integrative model was expanded upon to explain linkages between the three coordination mechanisms. CONCLUSIONS Planning is an essential element of leadership behavior and is primarily accomplished by a designated team leader. Communication affects medical performance, serving as the vehicle for the transmission of information and directions between team members. Our findings also suggest teams providing CPR must continuously verbalize their coordination plan in order to effectively structure allocation of subtasks and optimize success.
Collapse
|
24
|
Casagrande R, Wills N, Kramer E, Sumner L, Mussante M, Kurinsky R, McGhee P, Katz L, Weinstock DM, Coleman CN. Using the Model of Resource and Time-Based Triage (MORTT) to Guide Scarce Resource Allocation in the Aftermath of a Nuclear Detonation. Disaster Med Public Health Prep 2013; 5 Suppl 1:S98-110. [DOI: 10.1001/dmp.2011.16] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
ABSTRACTConventional triage algorithms assume unlimited medical resource availability. After a nuclear detonation, medical resources are likely to be particularly limited, suggesting that conventional triage algorithms need to be rethought. To test various hypotheses related to the prioritization of victims in this setting, we developed the model of resource- and time-based triage (MORTT). This model uses information on time to death, probability of survival if treated and if untreated, and time to treat various types of traumatic injuries in an agent-based model in which the time of medical practitioners or materials can be limited. In this embodiment, MORTT focuses solely on triage for surgical procedures in the first 48 hours after a nuclear detonation. MORTT determines the impact on survival based on user-selected prioritization of victims by severity or type of injury. Using MORTT, we found that in poorly resourced settings, prioritizing victims with moderate life-threatening injuries over victims with severe life-threatening injuries saves more lives and reduces demand for intensive care, which is likely to outstrip local and national capacity. Furthermore, more lives would be saved if victims with combined injury (ie, trauma plus radiation >2 Gy) are prioritized after nonirradiated victims with similar trauma.(Disaster Med Public Health Preparedness. 2011;5:S98-S110)
Collapse
|
25
|
Cole EM, West A, Davenport R, Naganathar S, Kanzara T, Carey M, Brohi K. Can residents be effective trauma team leaders in a major trauma centre? Injury 2013; 44:18-22. [PMID: 21999937 DOI: 10.1016/j.injury.2011.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 08/25/2011] [Accepted: 09/19/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The overall objective of this study was to compare senior Emergency Department (ED) trainees (residents) with consultant trauma team leaders, assessing their influence on trauma team performance and patient outcomes. We aimed to identify the effect of seniority of leader on time-based performance measures and clinical outcomes. METHODS This retrospective study of prospectively collected data was conducted in an urban Major Trauma Centre which has a well-established trauma team. For the period covered by this study the trauma team was led by either an ED consultant or specialist registrar having completed a local trauma team leader development programme. Data from all adult trauma team activations for seriously injured trauma patients (ISS - Injury Severity Score >15) presenting between 1st January 2008 and 31st October 2009 were included. Performance measures included time to FAST, time to CT scan and time to haemorrhage control. Patient outcomes were mortality, critical care and hospital length of stay. RESULTS There were 579 patients seriously injured in the study period. Trainees led 126 (22%) of the trauma teams. Significant differences in times to diagnostics or haemorrhage control between trainees and consultants were only seen in patients presenting with shock. Compared with trainees, consultant team leaders were significantly more likely to achieve targets for diagnostic imaging (FAST <15 min: consultants 97% vs. 33% trainees, p<0.01; CT scan <60 min: 76% vs. 50%, p<0.01) and haemorrhage control (surgery or angiography <60 min: 82% vs. 54%, p<0.001). There was no significant difference in overall mortality between consultants and trainees (consultants 25% vs. trainees 27%, p 1.00). Critical care length of stay was also the same for both (consultants median 5 days vs. trainees median 5 days). CONCLUSIONS Consultant team leaders improve team performance, resulting in shorter times to diagnostic imaging, and faster transfer to haemorrhage control. The greatest benefit seems to be for bleeding patients. Clinical outcomes were similar for trainees and consultants in our major trauma centre.
Collapse
Affiliation(s)
- E M Cole
- Trauma Outcomes Core, Centre for Neuroscience and Trauma Science, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
26
|
Steinemann S, Berg B, Skinner A, DiTulio A, Anzelon K, Terada K, Oliver C, Ho HC, Speck C. In situ, multidisciplinary, simulation-based teamwork training improves early trauma care. JOURNAL OF SURGICAL EDUCATION 2011; 68:472-7. [PMID: 22000533 DOI: 10.1016/j.jsurg.2011.05.009] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 05/02/2011] [Accepted: 05/17/2011] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Evaluate the impact of a team training curriculum for residents and multidisciplinary trauma team members on team communication, coordination and clinical efficacy of trauma resuscitation. DESIGN Prospective, cohort intervention comparing pre- vs. post-training performance. The intervention was a human patient simulator (HPS)-based, in situ team training curriculum, comprising a one-hour web based didactic followed by HPS training in the emergency department (ED). Teams were trained in multidisciplinary groups of 5-8 persons. Each HPS session included three fifteen minute scenarios with immediate video-enabled debriefing. Structured debriefing and teamwork assessment was performed with a modified NOTECHS scale for trauma (T-NOTECHS). Teams were assessed for performance changes during HPS-based training, as well as in actual trauma resuscitations. SETTING The Queen's Trauma Center (Level II); the primary teaching hospital for the University of Hawaii Surgical Residency. PARTICIPANTS 137 multidisciplinary trauma team members, including residents (n = 24), ED and trauma attending physicians, nurses, respiratory therapists, and ED technicians. RESULTS During HPS-based training sessions, significant improvements in teamwork ratings, and in clinical task speed and completion rates were noted between the first and the last scenario.244 real-life blunt trauma resuscitations were observed for six months before and after training. There was a significant improvement in mean teamwork scores from the pre-to post-training resuscitations. Moreover, there were significant improvements in the objective parameters of speed and completeness of resuscitation. This was manifest by a 76% increase in the frequency of near-perfect task completion (≤ 1 unreported task), and a reduction in the mean overall ED resuscitation time by 16%. CONCLUSIONS A relatively brief (four-hour) HPS-based curriculum can improve the teamwork and clinical performance of multidisciplinary trauma teams that include surgical residents. This improvement was evidenced both in simulated and actual trauma settings, and across teams of varying composition. HPS-based trauma teamwork training appears to be an educational method that can impact patient care.
Collapse
Affiliation(s)
- Susan Steinemann
- University of Hawaii, Department of Surgery, Honolulu, Hawaii 96813, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Frink M, Mommsen P, Andruszkow H, Zeckey C, Krettek C, Hildebrand F. Challenges of surgical trauma emergency admission. Langenbecks Arch Surg 2011; 396:499-505. [PMID: 21384186 DOI: 10.1007/s00423-011-0771-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 02/24/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Trauma still remains as one of the leading causes for mortality in Western civilization. The early clinical management of severely injured patients leads to structural and organizational challenges involving different specialties. EMERGENCY DEPARTMENT Trauma team leaders have to coordinate diagnostic and therapeutic steps in cooperation with different involved specialties. Furthermore, they have to make decisions based on contrary department-depending assessments. In addition, several special injuries commonly found in multiple traumatized patients require special attention. RECENT DEVELOPMENT Actually, structural changes in generating trauma networks are to be mentioned. Trauma networks suggest to improve patients survival in close cooperation between hospitals with different structural and personal capabilities. Close communication networks are required to guarantee transportation to an adequate trauma center.
Collapse
Affiliation(s)
- Michael Frink
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | | | | | | | | | | |
Collapse
|
28
|
Georgiou A, Lockey DJ. The performance and assessment of hospital trauma teams. Scand J Trauma Resusc Emerg Med 2010; 18:66. [PMID: 21144035 PMCID: PMC3017008 DOI: 10.1186/1757-7241-18-66] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 12/13/2010] [Indexed: 11/10/2022] Open
Abstract
The purpose of the trauma team is to provide advanced simultaneous care from relevant specialists to the seriously injured trauma patient. When functioning well, the outcome of the trauma team performance should be greater than the sum of its parts. Trauma teams have been shown to reduce the time taken for resuscitation, as well as time to CT scan, to emergency department discharge and to the operating room. These benefits are demonstrated by improved survival rates, particularly for the most severely injured patients, both within and outside of dedicated trauma centres. In order to ensure the best possible performance of the team, the leadership skills of the trauma team leader are essential and their non-technical skills have been shown to be particularly important. Team performance can be enhanced through a process of audit and assessment of the workings of the team and the evidence currently available suggests that this is best facilitated through the process of video review of the trauma resuscitation. The use of human patient simulators to train and assess trauma teams is becoming more commonplace and this technique offers a safe environment for the future education of trauma team staff. Trauma teams are a key component of most programmes which set out to improve trauma care. This article reviews the background of trauma teams, the evidence for benefit and potential techniques of performance assessment. The review was written after a PubMed, Ovid, Athens, Cochrane and guideline literature review of English language articles on trauma teams and their performance and hand searching of references from the relevant searched articles.
Collapse
|
29
|
Calleja P, Aitken LM, Cooke ML. Information transfer for multi-trauma patients on discharge from the emergency department: mixed-method narrative review. J Adv Nurs 2010; 67:4-18. [DOI: 10.1111/j.1365-2648.2010.05494.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
30
|
Künzle B, Zala-Mezö E, Kolbe M, Wacker J, Grote G. Substitutes for leadership in anaesthesia teams and their impact on leadership effectiveness. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2010. [DOI: 10.1080/13594320902986170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
31
|
Video registration of trauma team performance in the emergency department: the results of a 2-year analysis in a Level 1 trauma center. ACTA ACUST UNITED AC 2010; 67:1412-20. [PMID: 20009695 DOI: 10.1097/ta.0b013e31818d0e43] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Trauma teams responsible for the first response to patients with multiple injuries upon arrival in a hospital consist of medical specialists or resident physicians. We hypothesized that 24-hour video registration in the trauma room would allow for precise evaluation of team functioning and deviations from Advanced Trauma Life Support (ATLS) protocols. METHODS We analyzed all video registrations of trauma patients who visited the emergency room of a Level I trauma center in the Netherlands between September 1, 2000, and September 1, 2002. Analysis was performed with a score list based on ATLS protocols. RESULTS From a total of 1,256 trauma room presentations, we found a total of 387 video registrations suitable for analysis. The majority of patients had an injury severity score lower than 17 (264 patients), whereas 123 patients were classified as multiple injuries (injury severity score >or=17). Errors in team organization (omission of prehospital report, no evident leadership, unorganized resuscitation, not working according to protocol, and no continued supervision of the patient) lead to significantly more deviations in the treatment than when team organization was uncomplicated. CONCLUSIONS Video registration of diagnostic and therapeutic procedures by a multidisciplinary trauma team facilitates an accurate analysis of possible deviations from protocol. In addition to identifying technical errors, the role of the team leader can clearly be analyzed and related to team actions. Registration strongly depends on availability of video tapes, timely started registration, and hardware functioning. The results from this study were used to develop a training program for trauma teams in our hospital that specifically focuses on the team leader's functioning.
Collapse
|
32
|
Lott C, Araujo R, Cassar MR, Di Bartolomeo S, Driscoll P, Esposito I, Gomes E, Goode P, Gwinnutt C, Huepfl M, Lippert F, Nardi G, Robinson D, Roessler M, Davis M, Thies KC. The European Trauma Course (ETC) and the team approach: past, present and future. Resuscitation 2009; 80:1192-6. [PMID: 19632023 DOI: 10.1016/j.resuscitation.2009.06.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 06/14/2009] [Accepted: 06/21/2009] [Indexed: 11/17/2022]
Abstract
The European Trauma Course (ETC) was officially launched during the international conference of the European Resuscitation Council (ERC) in 2008. The ETC was developed on behalf of ESTES (European Society of Trauma and Emergency Surgery), EuSEM (European Society of Emergency Medicine), the ESA (European Society of Anaesthesiology) and the ERC. The objective of the ETC is to provide an internationally recognised and certified life support course, and to teach healthcare professionals the key principles of the initial care of severely injured patients. Its core elements, that differentiates it from other trauma courses, are a strong focus on team training and a novel modular design that is adaptable to the differing regional European requirements. This article describes the lessons learnt during the European Trauma Course development and provides an outline of the planned future development.
Collapse
Affiliation(s)
- Carsten Lott
- Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Chua WC, D'Amours SK, Sugrue M, Caldwell E, Brown K. Performance and consistency of care in admitted trauma patients: our next great opportunity in trauma care? ANZ J Surg 2009; 79:443-8. [DOI: 10.1111/j.1445-2197.2009.04946.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Sugrue M, Caldwell E, D’Amours S, Crozier J, Wyllie P, Flabouris A, Sheridan M, Jalaludin B. TIME FOR A CHANGE IN INJURY AND TRAUMA CARE DELIVERY: A TRAUMA DEATH REVIEW ANALYSIS. ANZ J Surg 2008; 78:949-54. [DOI: 10.1111/j.1445-2197.2008.04711.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
35
|
Effects of Nationwide Training of Multiprofessional Trauma Teams in Norwegian Hospitals. ACTA ACUST UNITED AC 2008; 64:1613-8. [DOI: 10.1097/ta.0b013e31812eed68] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Carroll K, Iedema R, Kerridge R. Reshaping ICU ward round practices using video-reflexive ethnography. QUALITATIVE HEALTH RESEARCH 2008; 18:380-390. [PMID: 18235161 DOI: 10.1177/1049732307313430] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In this article, we outline a study method with which structural changes to clinical communication were achieved within a local intensive care unit (ICU). The study method involved in-depth, round-the-clock observation, interviewing, and video filming of how intensivists conducted their practices, as well as showing selected footage to the clinicians for feedback. This feedback component iteratively engaged clinicians in problem-solving their own communication difficulties. The article focuses on one such feedback meeting and describes changes to the morning ward round and planning meeting that this feedback process catalyzed: greater time efficiency, a greater presence of intensivists in the ICU, more satisfied nursing staff, and a handover sheet to improve the structure of clinical information exchanges. We argue that in embodying not a descriptive but an interventionist approach to health service provision, this video-ethnographic method has great significance for enhancing clinicians' and researchers' understanding of the rising complexity of in-hospital practices, and for enabling them to intervene in these practices.
Collapse
Affiliation(s)
- Katherine Carroll
- Faculty of Humanities and Social Services, University of Technology, Sydney, NSW 2007, Australia.
| | | | | |
Collapse
|
37
|
Training Operating Room Teams in Damage Control Surgery for Trauma: A Followup Study of the Norwegian Model. J Am Coll Surg 2007; 205:712-6. [DOI: 10.1016/j.jamcollsurg.2007.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 06/03/2007] [Accepted: 06/05/2007] [Indexed: 11/22/2022]
|
38
|
Thomas EJ, Taggart B, Crandell S, Lasky RE, Williams AL, Love LJ, Sexton JB, Tyson JE, Helmreich RL. Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial. J Perinatol 2007; 27:409-14. [PMID: 17538634 DOI: 10.1038/sj.jp.7211771] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To add a team training and human error curriculum to the Neonatal Resuscitation Program (NRP) and measure its effect on teamwork. We hypothesized that teams that received the new course would exhibit more teamwork behaviors than those in the standard NRP course. STUDY DESIGN Interns were randomized to receive NRP with team training or standard NRP, then video recorded when they performed simulated resuscitations at the end of the day-long course. Outcomes were assessed by observers blinded to study arm allocation and included the frequency or duration of six team behaviors: inquiry, information sharing, assertion, evaluation of plans, workload management and vigilance. RESULT The interns in the NRP with team training group exhibited more frequent team behaviors (number of episodes per minute (95% CI)) than interns in the control group: information sharing 1.06 (0.24, 1.17) vs 0.13 (0.00, 0.43); inquiry 0.35 (0.11, 0.42) vs 0.09 (0.00, 0.10); assertion 1.80 (1.21, 2.25) vs 0.64 (0.26, 0.91); and any team behavior 3.34 (2.26, 4.11) vs 1.03 (0.48, 1.30) (P-values <0.008 for all comparisons). Vigilance and workload management were practiced throughout the entire simulated code by nearly all the teams in the NRP with team training group (100% for vigilance and 88% for workload management) vs only 53 and 20% of the teams in the standard NRP. No difference was detected in the frequency of evaluation of plans. CONCLUSION Compared with the standard NRP, NRP with a teamwork and human error curriculum led interns to exhibit more team behaviors during simulated resuscitations.
Collapse
Affiliation(s)
- E J Thomas
- The University of Texas Center of Excellence for Patient Safety Research and Practice, Houston, TX 77030, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Gao H, McDonnell A, Harrison DA, Moore T, Adam S, Daly K, Esmonde L, Goldhill DR, Parry GJ, Rashidian A, Subbe CP, Harvey S. Systematic review and evaluation of physiological track and trigger warning systems for identifying at-risk patients on the ward. Intensive Care Med 2007; 33:667-79. [PMID: 17318499 DOI: 10.1007/s00134-007-0532-3] [Citation(s) in RCA: 290] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Accepted: 01/04/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Physiological track and trigger warning systems (TTs) are used to identify patients outside critical care areas at risk of deterioration and to alert a senior clinician, Critical Care Outreach Service, or equivalent. The aims of this work were: to describe published TTs and the extent to which each has been developed according to established procedures; to review the published evidence and available data on the reliability, validity and utility of existing systems; and to identify the best TT for timely recognition of critically ill patients. DESIGN AND SETTING Systematic review of studies identified from electronic, citation and hand searching, and expert informants. Cohort study of data from 31 acute hospitals in England and Wales. MEASUREMENTS AND RESULTS Thirty-six papers were identified describing 25 distinct TTs. Thirty-one papers described the use of a TT, and five were studies examining the development or testing of TTs. None of the studies met all methodological quality standards. For the cohort study, outcome was measured by a composite of death, admission to critical care, 'do not attempt resuscitation' or cardiopulmonary resuscitation. Fifteen datasets met pre-defined quality criteria. Sensitivities and positive predictive values were low, with median (quartiles) of 43.3 (25.4-69.2) and 36.7 (29.3-43.8), respectively. CONCLUSION A wide variety of TTs were in use, with little evidence of reliability, validity and utility. Sensitivity was poor, which might be due in part to the nature of the physiology monitored or to the choice of trigger threshold. Available data were insufficient to identify the best TT.
Collapse
Affiliation(s)
- Haiyan Gao
- Intensive Care National Audit & Research Centre, Tavistock House, Tavistock Square, London, WC1H 9HR, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Hynes P, Kissoon N, Hamielec CM, Greene AM, Simone C. Dealing with aggressive behavior within the health care team: a leadership challenge. J Crit Care 2006; 21:224-7. [PMID: 16769473 DOI: 10.1016/j.jcrc.2005.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2005] [Revised: 09/27/2005] [Accepted: 11/22/2005] [Indexed: 11/19/2022]
Abstract
During an interdisciplinary Canadian leadership forum [ (click on the Conferences icon)], participants were challenged to develop an approach to a difficult leadership/management situation. In a scenario involving aggressive behavior among health care providers, participants identified that, before responding, an appropriate leader should collect additional information to identify the core problem(s) causing such behavior. Possibilities include stress; lack of clear roles, responsibilities, and standard operating procedures; and, finally, lack of training on important leadership/management skills. As a result of these core problems, several potential solutions are possible, all with potential obstacles to implementation. Additional education around communication and team interaction was felt to be a priority. In summary, clinical leaders probably have a great deal to gain from augmenting their leadership/management skills.
Collapse
Affiliation(s)
- Patricia Hynes
- Intensive Care Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
41
|
Abstract
AIM The aim of this ethnographic study was to explore the culture of a trauma team in relation to human factors. BACKGROUND Traumatic injury is the leading cause of death in the first four decades of life in the western world. Evidence suggests that the initial assessment and resuscitation of trauma victims is most successfully carried out by an organized trauma team. Most trauma teams use Advanced Trauma Life Support principles which focus on rapid assessment and management of the patient's injuries. Similarly, most trauma education focuses on Advanced Trauma Life Support principles, concentrating firmly on the patient's physical status. Nevertheless, contemporary literature about emergency teams suggests that human factors, such as communication and interprofessional relationships, can affect the team's performance regardless of how clinically skilled the team members are. METHOD Focused ethnography was used to explore the culture of a trauma team in one teaching hospital. Six periods of observation were undertaken followed by 11 semi-structured interviews with purposively chosen key personnel. Data from transcripts of the observation field notes and interviews were analysed using open coding, followed by formation of categories resulting in the emergence of six central categories. RESULTS Findings suggest that leadership, role competence, conflict, communication, the environment and the status of the patient all influence the culture of the trauma team. Interpretation of these categories suggests that trauma team education should include human factor considerations such as leadership skills, team management, interprofessional teamwork, conflict resolution and communication strategies. RELEVANCE FOR CLINICAL PRACTICE The findings suggest that support systems for role development of junior team leaders should be formalized. The proven airline industry techniques of Crew Resource Management, focusing on teamwork and effective communication, could be implemented into continuing professional development for trauma teams to engender collaboration and interprofessional practice.
Collapse
Affiliation(s)
- Elaine Cole
- A&E/Trauma, City University School of Nursing/Barts and The London NHS Trust, London, UK.
| | | |
Collapse
|
42
|
Fitzgerald MC, Bystrzycki AB, Farrow NC, Cameron PA, Kossmann T, Sugrue ME, Mackenzie CF. TRAUMA RECEPTION AND RESUSCITATION. ANZ J Surg 2006; 76:725-8. [PMID: 16916394 DOI: 10.1111/j.1445-2197.2006.03841.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The hospital reception phase of major trauma management requires a great number of expedient decisions. However, despite widely taught programmes advocating a standardized, algorithmic approach to decision-making, there is an ongoing rate of human errors contributing to adverse outcomes. It is now time for a fundamental change in our approach to trauma resuscitation. Point-of-care computer technology linked to real-time decision-making and trauma team coordination may achieve error reduction through standardized decision-making and a corresponding reduction in preventable mortality and morbidity.
Collapse
|
43
|
Ollerton JE, Sugrue M, Balogh Z, D'Amours SK, Giles A, Wyllie P. Prospective Study to Evaluate the Influence of FAST on Trauma Patient Management. ACTA ACUST UNITED AC 2006; 60:785-91. [PMID: 16612298 DOI: 10.1097/01.ta.0000214583.21492.e8] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have concentrated on the accuracy of Focused Assessment with Sonography in Trauma (FAST), but evaluation of whether FAST changes subsequent management has not been fully assessed. METHODS This prospective study compared 419 trauma admissions in two groups, FAST and no-FAST, for demographics, time of resuscitation, and action after resuscitation. The 194 patients undergoing FAST had their management plan specified before, and confirmed after, FAST was performed to assess for change in management. To ensure scan consistency and to minimize bias, criteria were established to define an adequate FAST. RESULTS FAST was performed in 194 patients (46%), assessing for free fluid. Management was changed in 59 cases (32.8%) after FAST. Laparotomy was prevented in 1 patient, computed tomography was prevented in 23 patients, and diagnostic peritoneal lavage was prevented in 15 patients. Computed tomography rates were reduced from 47% to 34% and diagnostic peritoneal lavage rates were reduced from 9% to 1%. CONCLUSIONS FAST plays a key role in trauma, changing subsequent management in an appreciable number of patients.
Collapse
Affiliation(s)
- J E Ollerton
- Department of Trauma, Liverpool Hospital, New South Wales, Australia.
| | | | | | | | | | | |
Collapse
|
44
|
Smith J, Caldwell E, Sugrue M. Difference in trauma team activation criteria between hospitals within the same region. Emerg Med Australas 2005; 17:480-7. [PMID: 16302941 DOI: 10.1111/j.1742-6723.2005.00780.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The present study was conducted to establish the current criteria for trauma team activation (TTA) in hospitals in the Metropolitan Sydney area, and examine the rationale behind their use. METHODS A cross-sectional survey was undertaken of the seven hospitals in the Metropolitan Sydney area designated to receive adult major trauma in March 2004. Trauma coordinators in each hospital provided the criteria used for adult TTA within their hospital. RESULTS All seven hospitals replied with their TTA criteria and completed the survey. The results show a wide variation in those criteria used by hospitals to activate their trauma team. Universally used criteria included penetrating injury to the head, neck or torso, limb amputation, spinal cord injury and systolic blood pressure <90 mmHg. Physiological limits for TTA varied between hospitals, with different limits for pulse rate and GCS used in different hospitals. All hospitals used mechanism of injury criteria alone as an activation prompt. CONCLUSIONS The criteria for TTA differ between hospitals within the same region. The criteria currently used will result in over-triage of trauma patients, but this might be of benefit in training the trauma team in centres that do not see a large volume of trauma patients. There are several advantages in standardization of criteria including optimization of patient care, training, research and audit. Further work is needed to validate existing criteria for use throughout the region.
Collapse
Affiliation(s)
- Jason Smith
- Department of Trauma, Liverpool Hospital, Liverpool, New South Wales, Australia.
| | | | | |
Collapse
|
45
|
Gross T, Amsler F, Ummenhofer W, Zuercher M, Jacob AL, Messmer P, Huegli RW. Multiple-trauma management. Eur J Anaesthesiol 2005; 22:754-61. [PMID: 16211733 DOI: 10.1017/s0265021505001250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE Staff attitude plays a pivotal role in quality management. The objective of the present study was to further define how interdisciplinary emergency hospital staff experience their daily work and the extent to which the professional speciality and training of an individual influences his/her assessment of multiple-trauma team performance. METHODS The clinical staff involved in multiple-trauma emergency management of a university hospital was asked to answer a confidential questionnaire. Factorial analysis was used to identify 8 major dimensions from a total of 53 items. RESULTS The questionnaire was returned by 128 team members. All professional groups were most dissatisfied with the dimensions 'education and training', 'work sequence between specialities' and 'communication between specialities'. Assessment of the quality of in-hospital emergency-trauma management differed significantly between professional specialities (ANOVA, F=5.2; P=0.028); surgeons gave the highest ratings for all but one dimension. Having taken an Advanced Trauma Life Support (ATLS) course influenced significantly the total rating of multiple-trauma treatments of anaesthetists and surgeons (F=5.5; P=0.024). CONCLUSIONS The perceptions of interdisciplinary trauma team members without the completion of an ATLS training course were that they did not communicate enough with each other and that there were differences between their expectations and reality. The differences and the communication deficits were overcome in team members who had passed an ATLS course.
Collapse
Affiliation(s)
- T Gross
- University Hospital, Department of Surgery, Trauma Unit, Basel, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
46
|
Bergs EAG, Rutten FLPA, Tadros T, Krijnen P, Schipper IB. Communication during trauma resuscitation: do we know what is happening? Injury 2005; 36:905-11. [PMID: 15998511 DOI: 10.1016/j.injury.2004.12.047] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 12/24/2004] [Accepted: 12/28/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Verbal communication is essential for teamwork and leadership in high-intensity performances like trauma resuscitation. We evaluated communication during multidisciplinary trauma resuscitation. METHODS The main trauma room of a level one trauma centre was equipped with a digital video recording system. Resuscitations were consecutively and prospectively enrolled. Patients with revised trauma score (RTS)=12 were resuscitated by a 'minor trauma team' and patients with RTS<12 by a 'major trauma team'. Information transferral from physicians to other team members was evaluated separately for all ABCDE's, according to initiation, audibility and response. The observer was trained and the first 30 video's were excluded. RESULTS From May 1st to September 1st 2003, 205 resuscitations were included, 12 were lost for evaluation. The 'major trauma team' resuscitated 74 patients (ISS:21.4). Communication was audible in 56% and understandable in 44% during the primary survey. The 'minor trauma team' assessed 119 patients (ISS:7.4). Communication was audible in 43% and understandable in 33%. CONCLUSIONS Communication during trauma resuscitation was found to be sub optimal. This is potentially harmful for trauma victims. Professionals and institutions should be aware that communication is not self-evident. Introduction of an aviation-like communication feedback system could help to optimise trauma care.
Collapse
Affiliation(s)
- Engelbert A G Bergs
- Department of Surgery, Traumacenter of the South-West Netherlands, ErasmusMC, University Hospital Rotterdam, Rotterdam, Netherlands.
| | | | | | | | | |
Collapse
|
47
|
Kühne CA, Ruchholtz S, Sauerland S, Waydhas C, Nast-Kolb D. [Personnel and structural requirements for the shock trauma room management of multiple trauma. A systematic review of the literature]. Unfallchirurg 2005; 107:851-61. [PMID: 15459805 DOI: 10.1007/s00113-004-0813-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The aim of the study was the description of personal and structural preconditions essential for adequate diagnostic requirements and treatment in severely injured patients. Herein we give detailed information regarding both the composition and qualification of the trauma team and the activation criteria as well as instructions for the design of the emergency room and technical requirements. Clinical trials were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system). The trauma team should consist of (trauma) surgeons, anesthesiologists, radiologists, and one to two nursing staff members of each department. The attending physician should be present within 20 min. Trauma team activation criteria are among others: high energy/velocity trauma, penetrating injuries, GCS < or =14, and intubation. The emergency room should be integrated in the emergency department with all technical equipment being permanently available for optimal diagnostic and therapeutic management. A CT scanner should be positioned nearby.Adequate management of severely injured patients requires optimal personal and structural conditions. High costs and additional personnel are justified by improved quality of treatment.
Collapse
Affiliation(s)
- C A Kühne
- Klinik für Unfallchirurgie, Universitätsklinikum, Essen.
| | | | | | | | | |
Collapse
|
48
|
Abstract
BACKGROUND Trauma teams have been associated with improved trauma patient outcomes. The present study seeks to estimate the use of trauma teams in Australian hospitals and describe their medical composition, leadership and criteria for activation. METHODS Australian public hospitals with more than 100 beds, an emergency department and offering surgical services were identified. A survey assessing the presence, composition and means of activation of a trauma team was mailed to the 'Director, Emergency Department' of all identified hospitals. Three months later, all hospitals were contacted by telephone to complete and verify data collection. RESULTS Questionnaires were distributed to 130 hospitals. After exclusion of hospitals that did not receive patients with traumatic injuries, and dedicated paediatric tertiary referral centres, 111 hospitals remained for analysis. Of these, 56% had an established trauma team, while 71% of hospitals without a trauma team claimed to have insufficient doctors to form one team. Ninety-five per cent of trauma teams were potentially activated by prehospital paramedic data (field triage). For 92% of trauma teams a combination of anatomical, physiological and mechanistic criteria were required for activation. The most common methods of mobilizing a trauma team were by dispatching a common call onto individual pagers (31%) or by paging trauma team members individually (31%). Fifty-eight per cent of trauma team leaders were emergency medicine specialists/registrars, while 8% of trauma teams were led by surgeons/registrars. Consultant surgeons were members of 23% of trauma teams and 74% of trauma teams consisted of more junior members after hours. Some form of trauma audit was engaged in by 64% of hospitals. CONCLUSIONS Trauma teams are yet to be utilized by many Australian hospitals that provide trauma care. Australian surgeons presently have limited leadership roles and membership in trauma teams. Trauma audit can be more widely adopted in Australian hospitals.
Collapse
Affiliation(s)
- Kenneth Wong
- Department of Trauma, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
| | | |
Collapse
|
49
|
D'Amours SK, Sugrue M, Deane SA. Initial management of the poly-trauma patient: a practical approach in an Australian major trauma service. Scand J Surg 2002; 91:23-33. [PMID: 12075831 DOI: 10.1177/145749690209100105] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The initial management of the poly-trauma patient is of vital importance to minimizing both patient morbidity and mortality. We present a practical approach to the early management of a severely injured patient as practiced at Liverpool Hospital in Sydney, Australia. Specific attention is paid to innovations in care and specific controversies in early management as well as local solutions to challenging problems.
Collapse
Affiliation(s)
- S K D'Amours
- Department of Trauma Surgery, Liverpool Hospital, Sydney, Australia
| | | | | |
Collapse
|
50
|
Holcomb JB, Dumire RD, Crommett JW, Stamateris CE, Fagert MA, Cleveland JA, Dorlac GR, Dorlac WC, Bonar JP, Hira K, Aoki N, Mattox KL. Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training. THE JOURNAL OF TRAUMA 2002; 52:1078-85; discussion 1085-6. [PMID: 12045633 DOI: 10.1097/00005373-200206000-00009] [Citation(s) in RCA: 196] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human patient simulation (HPS) has been used since 1969 for teaching purposes. Only recently has technology advanced to allow application to the complex field of trauma resuscitation. The purpose of our study was to validate an advanced HPS as an evaluation tool of trauma team resuscitation skills. METHODS The pilot study evaluated 10 three-person military resuscitation teams from community hospitals that participated in a 28-day rotation at a civilian trauma center. Each team consisted of physicians, nurses, and medics. Using the HPS, teams were evaluated on arrival and again on completion of the rotation. In addition, the 10 trauma teams were compared with 5 expert teams composed of experienced trauma surgeons and nurses. Two standardized trauma scenarios were used, representing a severely injured patient with multiple injuries and with an Injury Severity Score of 41 (probability of survival, 50%). Performance was measured using a unique human performance assessment tool that included five scored and eight timed tasks generally accepted as critical to the initial assessment and treatment of a trauma patient. Scored tasks included airway, breathing, circulation, and disability assessments as well as overall organizational skills and a total score. The nonparametric Wilcoxon test was used to compare the military teams' scores for scenarios 1 and 2, and the comparison of the military teams' final scores with the expert teams. A value of p < 0.05 was considered significant. RESULTS The 10 military teams demonstrated significant improvement in four of the five scored (p < or = 0.05) and six of the eight timed (p < or = 0.05) tasks during the final scenario. This improvement reflects the teams' cumulative didactic and clinical experience during the 28-day trauma refresher course as well as some degree of simulator familiarization. Improved final scores reflected efficient and coordinated team efforts. The military teams' initial scores were worse than the expert group in all categories, but their final scores were only lower than the expert groups in 2 of 13 measurements (p < or = 0.05). CONCLUSION No studies have validated the use of the HPS as an effective teaching or evaluation tool in the complex field of trauma resuscitation. These pilot data demonstrate the ability to evaluate trauma team performance in a reproducible fashion. In addition, we were able to document a significant improvement in team performance after a 28-day trauma refresher course, with scores approaching those of the expert teams.
Collapse
Affiliation(s)
- John B Holcomb
- Joint Trauma Training Center, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|