Establishing a standard for assessing the appropriateness of trauma team activation: a retrospective evaluation of two outcome measures

Bressan, Silvia; Franklin, Katherine L; Jowett, Helen; King, Sebastian K.; Oakley, Edward; Palmer, Cameron S

doi:10.1136/emermed-2014-203998

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…The main reason for a TTA is to identify such potentially life-threatening instability, and to restore airway control, and adequate ventilation and circulation. We believe, as other authors [20, 21], that the traditional ISS-based evaluation of TTA appropriateness should be complemented by the clinically recognized need for stabilizing emergency interventions. When we evaluated TTA against immediate emergency procedures, we found a slightly better undertriage, but still a high overtriage.…”

Section: Discussionmentioning

confidence: 75%

Evaluation of a trauma team activation protocol revision: a prospective cohort study

Dehli

Monsen²,

Fredriksen

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundCorrect triage based on prehospital information contributes to a better outcome for potentially seriously injured patients. In 2011 we changed the trauma team activation (TTA) criteria in our center in order to improve the high over- and undertriage properties of the protocol. Five criteria that were unable to predict severe injury were removed. In the present study, we evaluated the protocol revision by comparing over- and undertriage in the former and present set of criteria.MethodsAll severely injured patients (Injury Severity Score (ISS) > 15) and all patients admitted with TTA in the period of 01.01.2013 – 31.12.2014 were included in the study. We defined overtriage as the fraction of patients with TTA when ISS ≤15 and undertriage as the fraction of patients without TTA when ISS > 15. We also evaluated triage with the occurrence of emergency procedures immediately after admission.Results324 patients were included, 164 patients had ISS>15, 287 were admitted with TTA. Over- and undertriage were 74 % and 28 % respectively. When we used emergency procedure as reference, the figures were 83 % and 15 % respectively. Undertriaged patients had significantly more neurosurgical injuries and were significantly more often transferred from an acute care hospital.DiscussionOver- and undertriage are almost the same as before the criteria were revised, and higher thanrecommended levels.ConclusionsRevision of the TTA criteria has not improved triage, and further measures are necessary to achieveacceptable levels.

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Section: Discussionmentioning

confidence: 75%

Evaluation of a trauma team activation protocol revision: a prospective cohort study

Dehli

Monsen²,

Fredriksen

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…Hospital trauma care systems varied across the participating countries. The hospital trauma team, trauma protocol and education are the key elements of high‐quality trauma care . HICs have specialised trauma teams and trauma surgeons, while LMICs do not .…”

Section: Discussionmentioning

confidence: 99%

Comparison of trauma care systems in Asian countries: A systematic literature review

Choi

Kim

et al. 2017

Emerg Medicine Australasia

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“…Activating each injured ED patient into a trauma level initiates a chain of events and notifications designed to meet their anticipated clinical needs. 2,3 For example, Level 2 activations automatically mobilize radiology and laboratory technicians to immediately present to the ED to obtain emergency radiographs and blood specimens. A Level 1 activation does the same, but also activates operating room and anesthesia personnel to anticipate and prepare for emergent surgery.…”

Section: Introductionmentioning

confidence: 99%

“…The T sheet allows physicians to quickly document the key parts of an ED encounter by checking boxes and circling items for positive results, and crossing through negative finding fields. 3,4 T sheets have long been used in EDs, and are widely used as excellent tools to capture the necessary elements of an encounter for billing purposes. 4 Examples of T-sheets used for trauma cases include "Motor Vehicle Collision," and "Multiple Trauma.…”

Section: Introductionmentioning

confidence: 99%

“…It is therefore difficult for other providers to glean the critical details of the case when simply reviewing a T sheet. 3,4 In addition, T sheets do not currently allow documentation of ATLS protocol elements for major trauma patients. There are generally no areas which designate primary and secondary survey information or a section for procedures, critical aspects of the management of most all trauma patients and outlined by both the American College of Surgeons (ACS), and the Advanced Trauma Life Support (ATLS).…”

Section: Introductionmentioning

confidence: 99%

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Trauma Dictations in the Emergency Department: A Quality Improvement/Patient Safety Project

Toth

Richardson

Berry

et al. 2017

Spartan Medical Research Journal

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CONTEXT CONTEXT Trauma patients frequently represent a unique and challenging patient population in emergency medicine care settings. The policy of the McLaren Oakland Emergency Department (ED) is to have the treatment of all Level 1 and Level 2 trauma activations dictated by the ED resident. This policy is intended to facilitate both patient safety through clear communication between multiple medical services and quality improvement through reporting trauma specific quality metrics to third party agencies. Despite this requirement, trauma dictations in this setting were often found to not be completed. The purpose of this quality improvement/patient safety project was to implement a trauma dictation template to increase the rate of completed ED trauma dictations to above 75% of all Level 1 and Level 2 trauma activations. METHODS METHODS A trauma dictation template was created to aid ED residents while completing trauma dictations. It was thought by the authors that the implementation of a standardized dictation template would help residents specify the necessary components needed to improve both patient safety and quality reporting. The development of the template was a collaborative effort between the emergency medicine residents and faculty, the trauma coordinator and trauma surgeons. The project was evaluated using two separate measures. A "process measure" was first used to determine if the addition of the trauma template made dictating less burdensome for ED residents, and an "outcomes measure" helped the authors examine whether template implementation actually led to an increased rate in completed trauma dictation. RESULTS RESULTS Data were collected during a three-month period prior to template implementation and three months after implementation. From November, 2015 through April, 2016, a total of 132 Trauma Activations were reviewed. The rate of completed dictations on Level 1 trauma activations increased from 45.16% to 53.33%. However, the rate of dictations on Level 2 trauma activations decreased from 50% to 30.4%, suggesting that Level 1 trauma patient care may have derived greater improvements from the new dictation template. CONCLUSIONS CONCLUSIONS The results of the ED residents' evaluative survey responses were generally positive, indicating that the trauma template was perceived by most residents as a useful tool to complete dictations. Even though the outcome goal was not achieved, the project successfully achieved the goal of creating and implementing a usable trauma dictation template. Following the Plan-Do-Study-Act model for quality improvement/patient safety projects, the next project will examine additional barriers preventing users from utilizing this initial well-received tool.

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Establishing a standard for assessing the appropriateness of trauma team activation: a retrospective evaluation of two outcome measures

Abstract: Assessment of TTA appropriateness varied significantly based on the outcome measure used. FIs better reflected the use of acute-care TTA-related resources compared with the major trauma definition, and it should be used as the gold standard to prospectively assess and refine TTA criteria.

Cited by 10 publications

References 18 publications

Evaluation of a trauma team activation protocol revision: a prospective cohort study

Evaluation of a trauma team activation protocol revision: a prospective cohort study

Comparison of trauma care systems in Asian countries: A systematic literature review

Trauma Dictations in the Emergency Department: A Quality Improvement/Patient Safety Project

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