375 Improving Interdepartmental Trauma Evaluation and Resuscitation Through Mock In Situ Trauma Review and Debriefing

Abstract

Effective trauma resuscitation is essential to providing patients with an optimal outcome. We implemented a curriculum to review interdepartmental, interdisciplinary mock in situ traumas from the moment EMS calls our code line all the way through the patient’s disposition. Our primary goal is to streamline and standardize the evaluation and resuscitation of our trauma patients by improving interdepartmental communication skills, identifying and reviewing each member's role, reviewing the clinical management of ATLS algorithms, and reviewing ATLS procedural skills. Design: We created a curriculum to enhance the communication and skills of all members of our trauma team. The curriculum has two components: 1. The first component is an online PowerPoint module. All members of the trauma team are required to review. 2. The second component involves monthly unannounced mock in situ trauma codes. The trauma team's response to a trauma code is reviewed through focused debriefing with a team, strategically selected for their expertise. Our debriefing process occurs immediately after the conclusion of the case. Content experts have a checklist and focus on one of six critical actions. Each of these debriefers also has an opportunity to mention one other observation for improvement within their area of expertise. Our mock in situ traumas occur in the trauma bays in our emergency department. From August 2013- February 2017, we have had 32 mock in situ traumas. In total, we had 477 participants across 7 departments (emergency medicine, trauma surgery, respiratory therapy, radiology, EMS, orthopedic surgery and anesthesia) and across 9 professions (attending, physician assistant, resident, registered nurse, patient care assistant, certified registered nurse assistant, radiology technician, emergency medicine service, respiratory therapy). We tracked and classified most of our data throughout our mock in situ traumas into three categories. In the category of Leadership, we tracked: 1.The time taken for Verbal Identification of a team leader and 2. The team member’s awareness of who is the leader. In the Category of Team work and communication, we tracked: 1. Verbal role assignment to team members by the team leader, 2. The number of “thin air” commands and the total number of recaps, and 3. The Number of people in trauma box and nursing documentation. In the category of Clinical Outcomes, we tracked: 1. Room preparedness prior to patient arrival: a. Time to first set of Vitals, b. Time to primary assessment and c.Time to secondary assessment, 2. Number of critical actions completed and number of critical actions missed, 3. Formal hand off from ED to trauma team. We recognize limitations in this study: 1. Trauma codes are only run once a month.2. We did not assess any direct correlation with patient outcomes as we do not measure patient outcomes. 3. We only had one observer who consistently collected all data for every trauma. 4. We modified our checklist as we determined what was most relevant. Our online instructional course and mock in situ trauma codes are demonstrating improvement in mock in situ trauma evaluation and resuscitation. While medical proficiency is vital, teamwork and communication are the cornerstone of effective resuscitation. Our curriculum reinforces the tools that create a culture of teamwork and communication.