Trauma Team Response Research Articles

Pharmacists in Trauma: a randomised controlled trial of emergency medicine pharmacists in trauma response teams

BackgroundAnalgesia is an important component for patient well-being, but commonly delayed during trauma resuscitation. The Pharmacists in Trauma trial assessed the effects of integrating pharmacists into trauma response teams to...

Enhancing trauma care through innovative trauma and disaster team response training: A blended learning approach in Tanzania.

In Tanzania, inadequate infrastructures and shortages of trauma-response training exacerbate trauma-related fatalities. McGill University's Centre for Global Surgery introduced the Trauma and Disaster Team Response course (TDTR) to address these challenges. This study assesses the impact of simulation-based TDTR training on care providers' knowledge/skills and healthcare processes to enhance patient outcomes. The study used a pre-post-interventional design. TDTR, led by Tanzanian instructors at Muhimbili Orthopedic Institute from August 16-18, 2023, involved 22 participants in blended online and in-person approaches with simulated skills sessions. Validated tools assessed participants' knowledge/skills and teamwork pre/post-interventions, alongside feedback surveys. Outcome measures included evaluating 24-h emergency department patient arrival-to-care time pre-/post-TDTR interventions, analyzed using parametric and non-parametric tests based on data distributions. Participants' self-assessment skills significantly improved (median increase from 34 to 58, p<0.001), along with teamwork (median increase from 44.5 to 87.5, p<0.003). While 99% of participants expressed satisfaction with TDTR meeting their expectations, 97% were interested in teaching future sessions. The six-month post-intervention arrival-to-care time significantly decreased from 29 to 13min, indicating a 55.17% improvement (p<0.004). The intervention led to fewer ward admissions (35.26% from 51.67%) and more directed to operating theaters (29.83% from 16.85%), suggesting improved patient management (p<0.018). The study confirmed surgical skills training effectiveness in Tanzanian settings, highlighting TDTR's role in improving teamwork and healthcare processes that enhanced patient outcomes. To sustain progress and empower independent trauma educators, ongoing refresher sessions and expanding TDTR across low- and middle-income countries are recommended to align with global surgery goals.

A Retrospective Study on the Outcomes of Injuries From Border Wall Falls.

Objective Our retrospective cohort study focuses on the outcomes of injuries sustained from falls from the USA-Mexico border wall. The purpose of this study is to understand and predict the types of injuries that will be present in patients who fall from the border wall. This can further help trauma response teams to better predict and prepare for the care of these patients. Methods This retrospective cohort study included all patients that were admitted to Desert Regional Medical Center, a trauma I center, after a fall from the border wall that ranged from heights of 15 to 30 feet. The admissions occurred between March 2016 to December 2021. Results Of the 108 patients included, 38.2% (78) sustained at least one lower extremity injury, of which the most common was injury to the calcaneus bone. Additionally, there were several concomitant injuries, of which the combination of lower extremity and lumbar injury was found to be the most common (11.2%). The injury severity score (ISS) was found to not be statistically significant (ɑ=0.05) between groups of patients whose length of stay (LOS) in the hospital was greater than 10 days and less than 10 days. There was 1% fatality (1 of 108) and 92.5% required surgical intervention (100 of 108). Conclusions Patients injured from border wall falls are more likely to sustain lower extremity injuries than injuries to other parts of the body. Additionally, patients with lower extremity injuries sustained lumbar spinal injuries concomitantly, which can be most likely attributed to the axial compression of the spine during these falls. Most of these injuries required surgery and hospital admissions to treat. Understanding the patterns of injury from border wall falls can further help trauma response teams treat patients with efficient management.

Rethinking the tiered trauma team response: A case-series study in a regional trauma centre.

To reduce perceived unnecessary resource use, we modified our tiered trauma response. If a patient was not physiologically compromised, surgical registrar attendance was not mandated. We investigated the effect of this change on missed injury, unplanned representation to ED, diagnostic imaging rates and staff satisfaction. A retrospective case series study assessing the 3-month period before and after the intervention was conducted. Logistic regression analyses were used to examine the association between ordering of computerised tomography (CT) and ED length of stay (LOS), injury severity (ISS), age, surgical review and admission. A staff survey was conducted to investigate staff perceptions of the practice change. Free text data were analysed using inductive content analysis. There were 105 patients in the control and 166 in the intervention group and their mean (SD) ISS was the same (ISS [SD] = 4 [±4] [P = 0.608]). A higher proportion of the control group were admitted (56.3% vs 42.2% [P = 0.032]) and they had a shorter ED LOS (274 min [202-456] vs 326 min [225-560], P = 0.044). The rate of missed injury was unchanged. A surgical review resulted in a 26-fold increase in receipt of a whole-body CT scan (odds ratio = 26.89, 95% confidence interval = 3.31-218.17). Just over half of survey respondents felt the change was safe (54.4%), and more surgical (90%) than ED staff (69%) reported the change as positive. The removal of the surgical registrar from the initial trauma standby response did not result in any adverse events, reduced admissions, pathology and imaging, but resulted in an increased ED LOS and time to surgical review.

Clinical application of a body area network-based smart bracelet for pre-hospital trauma care.

This study aims to explore the efficiency and effectiveness of a body area network-based smart bracelet for trauma care prior to hospitalization. To test the efficacy of the bracelet, an observational cohort study was conducted on the clinical data of 140 trauma patients pre-admission to the hospital. This study was divided into an experimental group receiving smart bracelets and a control group receiving conventional treatment. Both groups were randomized using a random number table. The primary variables of this study were as follows: time to first administration of life-saving intervention, time to first administration of blood transfusion, time to first administration of hemostatic drugs, and mortality rates within 24 h and 28 days post-admission to the hospital. The secondary outcomes included the amount of time before trauma team activation and the overall length of patient stay in the emergency room. The measurement results for both the emergency smart bracelet as well as traditional equipment showed high levels of consistency and accuracy. In terms of pre-hospital emergency life-saving intervention, there was no significant statistical difference in the mortality rates between both groups within 224 h post-admission to the hospital or after 28-days of treatment in the emergency department. Furthermore, the treatment efficiency for the group of patients wearing smart bracelets was significantly better than that of the control group with regard to both the primary and secondary outcomes of this study. These results indicate that this smart bracelet has the potential to improve the efficiency and effectiveness of trauma care and treatment. A body area network-based smart bracelet combined with remote 5G technology can assist the administration of emergency care to trauma patients prior to hospital admission, shorten the timeframe in which life-saving interventions are initiated, and allow for a quick trauma team response as well as increased efficiency upon administration of emergency care.

Ambulance Response in Eight Minutes or Less: Are Comorbidities a Factor.

A recommended emergency medical services ambulance response time to a medical emergency is within eight minutes for at least 90% of calls. This study aimed to evaluate scene times for rural education and outreach to improve the quality of trauma care. This is a single-center study of Trauma Registry data from July 1, 2016 to February 28, 2022. The inclusion criteria were based upon age (≥18years). A logistic regression was performed to identify predictor variables on the likelihood that an adult trauma patient will experience scene times greater than eight minutes. 19321 patients were included in the analysis; 7233 (37%) experienced an elapsed scene time within eight minutes. This research identified an opportunity to improve rural trauma team response time, which is only reaching 37% of the patient population within eight minutes. Prehospital cardiac arrest and unique pre-existing comorbidities may play a role in extended response times by EMS.

Pediatric trauma in the rural and low resourced communities

Death and disability associated with traumatic injury can be significantly decreased with timely and appropriate care. Patients in rural areas tend to have disproportionately decreased access to this care, with the pediatric age group acting as a particularly difficult challenge for pre-hospital and rural hospital settings due to the unfamiliarity of those trauma response teams with pediatric age specific management guidelines as well as a disparity in resource availability. In this review, we attempt to discuss the challenges facing pediatric trauma care in the rural and low resourced communities, as well as initiatives that are being carried out to optimize this kind of care, such as pediatric readiness, rapid transportation to higher levels of care, availability of blood in rural centers as well as in transit, and the utility of telemedicine in improving rural pediatric trauma care.

Variation in Trauma Team Response Fees in United States Trauma Centers

Variation in Trauma Team Response Fees in United States Trauma Centers

Utilizing Near-Infrared Spectroscopy to Identify Pediatric Trauma Patients Needing Lifesaving Interventions: A Prospective Study.

The aim of this study was to prospectively investigate the role of near-infrared spectroscopy (NIRS) in identifying pediatric trauma patients who required lifesaving interventions (LSIs). Prospective cohort study of children age 0 to 18 years who activated the trauma team response between August 15, 2017, and February 12, 2019, at a large, urban pediatric emergency department (ED).The relationship between the lowest somatic NIRS saturation and the need for LSIs (based on published consensus definition) was investigated. Categorical variables were analyzed by χ 2 test, and continuous variables were analyzed by Student t test. A total of 148 pediatric trauma patients had somatic NIRS monitoring and met the inclusion criteria. Overall, 65.5% were male with a mean ± SD age of 10.9 ± 6.0 years. Injuries included 67.6% blunt trauma and 28.4% penetrating trauma with mortality of 3.4% (n = 5). Overall, the median lowest somatic NIRS value was 72% (interquartile range, 58%-88%; range, 15%-95%), and 43.9% of patients had a somatic NIRS value <70%. The median somatic NIRS duration recorded was 11 minutes (interquartile range, 7-17 minutes; range, 1-105 minutes). Overall, 36.5% of patients required a LSI including 53 who required a lifesaving procedure, 17 required blood products, and 17 required vasopressors. Among procedures, requiring a thoracostomy was significant.Pediatric trauma patients with a somatic NIRS value <70% had a significantly increased odds of requiring a LSI (odds ratio, 2.11; 95% confidence interval, 1.07-4.20). Somatic NIRS values <70% had a sensitivity and specificity of 56% and 63%, respectively. Pediatric trauma patients with somatic NIRS values <70% within 30 minutes of ED arrival have an increased odds of requiring LSIs. Among LSIs, pediatric trauma patients requiring thoracostomy was significant. The role of NIRS in incrementally improving the identification of critically injured children in the ED and prehospital setting should be evaluated in larger prospective multicenter studies.

Variation in Trauma Team Response Fees in United States Trauma Centers: An Additional Undisclosed Variable Cost in Trauma Care.

Background: The rising costs associated with trauma care in the United States is an important topic in today’s healthcare environment. Factors such as innovations in technology, increasing governmental and organizational regulations, and the specialization of care have led to increasing costs to the patient. A component of trauma cost is the one-time trauma team response fee (TTRF). The determination process of the TTRF’s dollar amount is elusive as no apparent standardized process exists and the literature is scant regarding this aspect of trauma care.Methods: A nationwide cross-sectional convenience sample was conducted using SurveyMonkey. Surveys were sent to 525 trauma centers in the continental United States, including Alaska and Hawaii, between October 8, 2019 and March 11, 2020. Additionally, hospital medical directors and trauma medical directors were queried on their knowledge of their facility’s TTRF amount.Results: Only 46 out of 525 trauma centers, or 8.8% of those surveyed shared their scheduled fees. Comparisons of TTRFs among different trauma centers, activation levels, and geographical locations were not statistically significant.Conclusions: Understanding the true costs of trauma care and fees for patients in the United States remains elusive due to inadequate data and low response rates. Trauma centers struggle to maintain financial viability as regulatory agencies and the public push for transparency of TTRFs. Collaboration between trauma centers and regulatory agencies is needed to ensure a balance between providing quality trauma care with justified associated charges and financial sustainability.

Impact of the UK National Lockdown on Trauma Patterns and the Prehospital Advanced Trauma Team Response within Metropolitan London

Introduction The societal changes triggered by the COVID-19 pandemic and resultant lockdowns have the potential to alter the incidence and nature of injuries within affected populations. We aimed to investigate these changes within Metropolitan London and the impact lockdown had on London's Air Ambulance's (LAA) response to incidents. Methods This retrospective cohort study compared data from all LAA missions in the two-month period following instigation of the 1st UK national lockdown in 2020 to the equivalent period in 2019. Patient demographics, nature and severity of injuries, incident details and LAA mission parameters were assessed. Results LAA saw a significant reduction in the mean (standard deviation) of activations per week under lockdown (32.75 [4.95] versus 54.25 [4.53], p&lt;0.001). The distribution of patients across different trauma aetiologies differed significantly under lockdown, with proportionately more injuries resulting from domestic violence (0.7% versus 3.8%) and deliberate self-harm (DSH [16.5% versus 12.4%]), although the absolute number of DSH fell. Significantly fewer incidents occurred in central areas of London, but injury severity was unaffected by lockdown. After adjustment for confounders, lockdown was associated with shorter drive times, but not overall response times. There was no association between lockdown and aetiology or severity of injuries. Conclusion The COVID-19 pandemic and ensuing UK national lockdown had a substantial impact on major trauma patterns within London and the subsequent LAA response. The feared rise in suicide was not observed, but there was a notable increase in domestic violence frequency.

Utilizing Near-Infrared Spectroscopy (NIRS) to Identify Pediatric Trauma Patients Needing Lifesaving Interventions (LSIs): A Retrospective Study.

The aim of this study was to investigate the role of near-infrared spectroscopy (NIRS) in identifying pediatric trauma patients who required lifesaving interventions (LSIs). Retrospective chart review of children age 0 to 18 years who activated the trauma team response between January 1, 2015 and August 14, 2017, at a large, urban pediatric emergency department. The lowest somatic NIRS saturation and the need for LSIs (based on published consensus definition) were abstracted from the chart. χ2 and descriptive statistics were used for analysis. The charts of 84 pediatric trauma patients were reviewed. Overall, 80% were boys with a mean age of 10.4 years (SD, 6.2 years). Injuries included 56% blunt trauma and 36% penetrating trauma with mortality of 10.7% (n = 9). Overall, the median lowest NIRS value was 67% (interquartile range, 51-80%; range, 15%-95%) and 54.8% of the patients had a NIRS value less than 70%. The median somatic NIRS duration recorded was 12 minutes (interquartile range, 6-17 minutes; range, 1-59 minutes). Overall, 50% of patients required a LSI, including 39 who required a lifesaving procedure, 11 required blood products, and 14 required vasopressors. Pediatric trauma patients with NIRS less than 70% had a significantly increased odds of requiring a LSI (odds ratio, 2.67; 95% confidence interval, 1.10-6.47). NIRS less than 70% had a sensitivity and specificity of 67% and 57% respectively. Pediatric trauma patients with somatic NIRS less than 70% within 30 minutes of emergency department arrival are associated with the need for LSIs. Continuous NIRS monitoring in the pediatric trauma population should be evaluated prospectively.

Predictors of Family Engagement in Child Post-Traumatic Stress Disorder Screening Following Exposure to Intimate Partner Violence.

Children's exposure to intimate partner violence (IPV) has numerous negative short- and long-term impacts on children's development, mental health, physical health, and adult functioning. While community-based organizations have an array of interventions aimed to increase survivor safety and prevent the development of, or treat post-traumatic stress disorder (PTSD), many families experiencing IPV never enter the doors of community-based organizations. To address this gap, there is an increasing number of partnerships between community-based organizations and first responders to increase support to families experiencing IPV. The Child Trauma Response Team (CTRT) is an innovative model that provides a coordinated, immediate, trauma-informed, and interdisciplinary response to families exposed to IPV. Given the lack of research on coordinated community interventions, the research questions for this study were as follows: (a) What are the family sociodemographic factors, crime factors, and program services most associated with family engagement in child PTSD screening following exposure to IPV? (b) What are the family sociodemographic factors and crime factors most associated with children screening positive for PTSD following exposure to IPV? The data for this study consist of 244 families with 352 children identified by the pilot CTRT. The results of this study suggest that a collaborative intervention designed to address caregiver and children's safety and well-being after a police-reported IPV incident is a promising model. Overall, more than 70% of children identified by the CTRT team completed a child PTSD screen, and 74.3% of children who completed the screens were screened positive for PTSD. The safety assessment service provided by the CTRT team was a predictor of the families' engagement in child PTSD screens. This is a critical finding and suggests the importance of developing program models that comprehensively address the needs of caregivers and children exposed to IPV.

Detecting and reducing post-traumatic stress among children exposed to domestic violence: A multi-agency early intervention program

Exposure to domestic violence (DV) has serious implications for youth, increasing risk for a range of problems, including post-traumatic stress. The Child Trauma Response Team is a multi-agency collaboration aimed at providing coordinated, immediate, trauma-informed, and interdisciplinary response to children and their impacted family members who are exposed to domestic violence. This mixed-methods study analyzed CTRT administrative data along with qualitative stakeholder interview data to describe the children and families served by CTRT, examine the reach of CTRT services, and articulate the lessons learned in the early stages of CTRT program implementation. Results show the majority of children accessing CTRT services were young and came from racial and/or ethnic minority backgrounds. The vast majority of families engaging with CTRT received safety assessment and planning and child trauma education, with many families receiving at least one other service. Stakeholders identified challenges to implementation as: identification of eligible families; initiating and ensuring program engagement; and collaboration and communication across multiple agencies. Several strategies to overcome these challenges were identified. Findings from this study indicate that, through inter-agency collaboration, reaching and serving children exposed to DV in the days and weeks immediately following a violent event is feasible—even in a large city with complex inter-agency relationships.

A novel streamlined trauma response team training improves imaging efficiency for pediatric blunt abdominal trauma patients

Background/purposeThe morbidity and mortality of children with traumatic injuries are directly related to the time to definitive management of their injuries. Imaging studies are used in the trauma evaluation to determine the injury type and severity. The goal of this project is to determine if a formal streamlined trauma response improves efficiency in pediatric blunt trauma by evaluating time to acquisition of imaging studies and definitive management. MethodsThis study is a chart review of patients <18 years who presented to a pediatric trauma center following blunt trauma requiring trauma team activation. 413 records were reviewed to determine if training changed the efficiency of CT acquisition and 652 were evaluated for FAST efficiency. The metrics used for comparison were time from ED arrival to CT image, FAST, and disposition. ResultsTime from arrival to CT acquisition decreased from 37 (SD 23) to 28 (SD27) min (p < 0.05) after implementation. The proportion of FAST scans increased from 315 (63.5%) to 337 (80.8%) and the time to FAST decreased from 18 (SD15) to 8 (SD10) min (p < 0.05). The time to operating room (OR) decreased after implementation. ConclusionThe implementation of a streamlined trauma team approach is associated with both decreased time to CT, FAST, OR, and an increased proportion of FAST scans in the pediatric trauma evaluation. This could result in the rapid identification of injuries, faster disposition from the ED, and potentially improve outcomes in bluntly injured children. Type of studyTherapeutic Level of evidenceLevel III

Quality of life and level of post-traumatic stress disorder among trauma patients: A comparative study between a regional and a university hospital

BackgroundThe aim of this study was to assess outcome in long-term quality of life (QoL) and post-traumatic stress disorder (PTSD) among adult survivors of trauma. Secondary aim was to compare levels of the outcome with injury severity and specialization level of two trauma centres.MethodsA retrospective study included patients received by the trauma response teams at two hospitals in 2013 aged 18 or more at follow-up. We assessed QoL and PTSD with one mailed questionnaire to each patient at either 12 or 24 months of follow-up. Health status was measured by EuroQol EQ-5D and the Glasgow Outcome Scale. PTSD symptoms were classified according to the Post-Traumatic Stress Disorder Checklist (PCL) and Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV).ResultsA questionnaire was mailed to 774 patients at end of 2014 or early 2015, 455 were included for analysis; median age 44 (IQR 25–57; 68% male); median NISS 9 (IQR 2–17); At follow-up 24% (95% CI 20–28) reported a EQ index score value equivalent to the lowest 2.3% in the Danish population norm. Probable PTSD was present in 19% (95% CI 13–27) of patients with severe injuries (NISS> 15), and 23% (95% CI 19–28) of those with NISS < 15.ConclusionSevere trauma has substantial impact on QoL and PTSD assessed at 12–24 months after the trauma. The QoL was well below the Danish population norm. The presence of PTSD was independent of injury severity. Trauma Centres should consider to include this as part of the treatment principles.

Providing Coordinated, Immediate, Trauma-Focused, and Interdisciplinary Responses to Children Exposed to Severe Intimate Partner Violence: Assessing Feasibility of a Collaborative Model.

Despite the known consequences associated with children's exposure to intimate partner violence (IPV), numerous children exposed to IPV never access victim services and/or mental health treatment. Informed by the Child Development-Community Policing Program (CD-CP), the Child Trauma Response Team (CTRT) is designed to provide a coordinated, immediate, trauma-informed, and interdisciplinary response to children, adolescents, and their impacted family members who are exposed to severe IPV. The aim of this study was to explore the feasibility of the CTRT from the perspective of the key stakeholders and to identify what facilitated and/or hindered the collaborative model. Interviews were conducted with all 12 CTRT stakeholders of whom three worked for law enforcement, four worked for the district attorney's office, four worked for the nonprofit victim service organization, and one worked for the city office funding the pilot. Results indicated that the CTRT program evolved through a cyclical process including (a) implementing and enhancing program services, (b) defining and nurturing partner relationships, and (c) shifting practices among partnering agencies. The results provide concrete tools and practices that were successful in the CTRT pilot implementation. Despite the potential barriers to successful multidisciplinary collaborations, it is critical that we invest in developing and implementing collaborative intervention models in the IPV field. The CTRT model is an innovative model that conducts multidisciplinary coordinated outreach to families experiencing severe IPV to enhance family engagement in services and, when appropriate, in the criminal justice process.

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

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.

Simulation and the diagnostic process: a pilot study of trauma and rapid response teams

Simulation is frequently used to recreate many of the crises encountered in patient care settings. Teams learn to manage these crises in an environment that maximizes their learning experiences and eliminates the potential for patient harm. By designing simulation scenarios that include conditions associated with diagnostic errors, teams can experience how their decisions can lead to errors. The purpose of this study was to assess how trauma teams (TrT) and pediatric rapid response teams (RRT) managed scenarios that included a diagnostic error. We developed four scenarios that would require TrT and pediatric RRT to manage an error in diagnosis. The two trauma scenarios (spinal cord injury and tracheobronchial tear) were designed to not respond to the heuristic management approach frequently used in trauma settings. The two pediatric scenarios (foreign body aspiration and coarctation of the aorta) had an incorrect diagnosis on admission. Two raters independently scored the scenarios using a rating system based on how teams managed the diagnostic process (search, establish and confirm a new diagnosis and initiate therapy based on the new diagnosis). Twenty-one TrT and 17 pediatric rapid response managed 51 scenarios. All of the teams questioned the initial diagnosis. The teams were able to establish and confirm a new diagnosis in 49% of the scenarios (25 of 51). Only 23 (45%) teams changed their management of the patient based on the new diagnosis. Simulation can be used to recreate conditions that engage teams in the diagnostic process. In contrast to most instruction about diagnostic error, teams learn through realistic experiences and receive timely feedback about their decision-making skills. Based on the findings in this pilot study, the majority of teams would benefit from an education intervention designed to improve their diagnostic skills.

Standardizing the initial resuscitation of the trauma patient with the Primary Assessment Completion Tool using video review.

Major trauma resuscitations at pediatric trauma centers have an elevated risk for error because of their high acuity and relatively low frequency. The Advanced Trauma Life Support (ATLS) treatment paradigm was established to improve the management of trauma patients during the initial resuscitation phase and has been shown to improve outcomes through a standardized approach. The goal of this quality improvement project was to decrease assessment physician variability and improve the compliance with the ATLS primary assessment for major resuscitations. A video review tool was developed to score the assessment physician on completion of the primary survey components using ATLS format. Interrater reliability and content validity were established for the tool. Data were collected through video review of the trauma response team in the emergency department for all Level 1 trauma alert activations with general consent. Chi-square and regression analyses were used to evaluate the data at 30 days, 6 months, and 1 year from the baseline period. A total of 142 patient videos were scored between July 28, 2015, and August 1, 2016. Eleven patients were reviewed during the baseline period, and only 9.1% of the total scores were ≥85. Thirty days following project implementation, 37.5% were ≥ 85. Six months following project implementation, 64.4% scored ≥85. One year following project implementation, 91.5% scored ≥85. These were statistically significant changes (p < .0001) with less variability over time. Effective leadership using a standardized approach during the trauma resuscitation has been found to have a positive effect on task completion and the overall functioning of the trauma team. This focused quality improvement project improved compliance with ATLS format and decreased variability by the assessment physician, potentially improving patient safety and outcomes. Therapeutic/care management study, level IV.