D. Ruter1, J. Um1, D. Evans1, C. Boulger2, C. Jones1 1The Ohio State University College Of Medicine,Department Of Surgery, Division Of Trauma, Critical Care And Burn,Columbus, OH, USA 2The Ohio State University College Of Medicine,Department Of Emergency Medicine,Columbus, OH, USA
Introduction: The unpredictable nature of trauma evaluation makes it vulnerable to human error, often communication related and occurring at times of handoff. In 2014, our university-based American College of Surgeons verified Level 1 trauma center developed a ‘Trauma Activation Checklist’ as a joint project between the Departments of Emergency Medicine and Surgery. The checklist included three sections: ‘sign in’ for introductions and preparation prior to patient arrival; ‘EMS timeout’ for attention to handoff by prehospital providers; and ‘sign out’ for planning imaging, consults, and patient disposition upon leaving the trauma bay. The checklist was posted prominently in each trauma bay and discussed during annual and monthly trauma team orientations. We sought to evaluate checklist use during the transition to new teams in July 2015.
Methods: During July 2015, trained observers monitored arrivals and evaluations of a convenience sample of patients seen as Level 1 (severely injured) and Level 2 (moderately injured) trauma activations. For each patient, they recorded the level of activation, time of day, and use of each checklist component as ‘checked’ or ‘not checked’. Failure to verbally acknowledge a checklist component led to its recording as ‘not checked’. No personally identifying data regarding patients were recorded. Descriptive statistics were performed to analyze use of the checklist.
Results: Our center evaluated 130 patients via trauma activation in July 2015. 46 evaluations (35%) were observed for checklist adherence, divided between daytime (7am-5pm, 16 patients, 35%), evening (5-10pm, 23, 50%) and nighttime (10p-7a, 7, 15%). The least frequently completed section was the sign out; only 7 (15%) of the trauma activations completed this section in its entirety. All sections of the checklist were more commonly completed in Level 1 trauma activations than in Level 2 trauma activations (sign in: 41% vs 24%; EMS timeout: 65% vs 38%; sign out: 24% vs 14%).The most commonly missed individual components in the sign in section were placing pre-arrival orders and obtaining equipment access. In the EMS timeout section, obtaining referring institution records was most commonly missed, while assuring intensive care unit handoff was the component most overlooked in the sign out section.
Conclusions: Despite prominent incorporation into trauma team training and its highly visible position in the trauma bay, a trauma activation checklist is used suboptimally in organizing the arrival and initial evaluation of injured patients at our academic medical center. Teams are particularly deficient in completing the sign out section and verbalizing forthcoming plans for patient care, especially for patients deemed less critically injured. Improvements to the checklist itself and to checklist adherence and its effects on information exchange and patient care are ongoing.