Flow Disruptions During Trauma Care

Abstract

This study is the largest direct observational study of the trauma process conducted to date. Complexities associated with the critical patient who arrives in the trauma bay lead to a high prevalence of disruptions related to breakdowns in coordination, communication, equipment issues, and environmental factors. Prospective observation allows individual hospitals to identify and analyze these systemic deficiencies. Appropriate interventions can then be evaluated to streamline the care provided to trauma patients.

Identifying Workflow Disruptions in Robotic-Assisted Bariatric Surgery: Elucidating Challenges Experienced by Surgical Teams

“…During RBS, we observed one FD every 2.4 min. This rate is more frequent than previously observed in gynecology, urology, and trauma surgery cases [ 17 , 18 , 27 ]. Coordination FDs occurred most frequently overall, followed by environment and communication FDs.…”

A Smartphone Application for Teamwork and Communication in Trauma: Pilot Evaluation “in the Wild”

“…We planned for one observer to follow 20 cases over the 3-month data collection period before and after the introduction of the app, recording FD, time spent in ED, and teamwork scores. As with our prior studies (Blocker et al, 2013; Catchpole et al, 2014; Shouhed et al, 2014), the observer was provided with a trauma pager and organized into an “on-call” rota during the day, and at weekends during the busiest trauma periods. As soon as the trauma was activated, the observer arrived in the ED and followed the course of patient care from arrival to disposition (discharge, ICU, surgery).…”

“…The unpredictable, time-pressured, team-based, and resource-dependent nature of trauma care provides multiple opportunities for disruptions, inefficiencies, and errors arising not from technical incompetence but from the complexity and challenges of the working environment (Shouhed et al, 2014). In the traditional trauma scenario, a call from the Emergency Medical Services (EMS) is taken by a specialist nurse at the receiving trauma center.…”

“…This also requires the coordination of multiple specialists distributed geographically across a hospital— emergency department (ED), trauma team, imaging technicians, operating room (OR) staff, intensive care unit (ICU) staff, and neurological and orthopedic consulting physician specialists—presenting unique challenges for cognition, teamwork, and coordination. Disruptions along the trauma pathway that arise from communication, coordination, and handoffs problems can delay progress through initial care, imaging diagnosis, and surgery to ICU disposition (Blocker et al, 2013; Catchpole et al, 2013; Shouhed et al, 2014), and affect acute patients in particular.…”

“…Initial observational studies found that flow disruptions that impacted care in the ED occurred at a rate of approximately nine per hour, leading to delays that then affected progress to further diagnostics (Blocker et al, 2013), and handoffs along the pathway (Catchpole et al, 2013), creating problems for acute patients in particular. Coordination accounted for 31% of the disruptions encountered, with another 21% based on communication problems (Shouhed et al, 2012). We found particular problems in imaging, where delays to care were substantial, with coordination and communication accounting for over 50% of the disruptions (Blocker et al, 2013).…”