C.M. Caswell1, W. Butak1, J. Gellings1, D. Wilson1, A. Tatakis1, A. Farah1, C. Jankowski2, D. Milia1, D. Holena1 1Medical College Of Wisconsin, Trauma And Acute Care Surgery, Milwaukee, WI, USA 2Medical College Of Wisconsin, Anesthesiology, Milwaukee, WI, USA
Introduction:
A smooth transition from the emergency department (ED) to the operating room (OR) for trauma patients requires many steps be performed efficiently. One of the most critical aspects of the transition from ED to OR, and subsequent timely initiation of surgery, is the preparedness of the OR.This is difficult to assess on a case-by-case basis at most centers due to a lack of available data. In 2024, our center initiated an intraoperative trauma video review program (IOTVR) as part of our quality improvement efforts. Using audiovisual recordings of trauma operations as a data source, we sought to describe the variability in OR preparedness for emergent trauma surgical cases.
Methods:
To assess the readiness of our dedicated trauma OR for emergent cases, we used audiovisual files from our IOTVR program of consecutive trauma cases between June to July of 2024. Using a REDCap data collection instrument based on readiness prompts from our institutional Trauma Anesthesia Checklist (TAC), we assessed room preparedness with respect to, anesthesia machinery, IV line and rapid infusers, underbody and esophageal warmers, airway management equipment, and emergency drugs. Setup time was defined as the period between anesthesia staff and patient arrival. We deemed equipment ready if prepared prior to the patient being wheeled into the OR. Additionally, we examined the impact of patient hemodynamic instability on the preparedness of the anesthesia team in the OR.
Results:
We analyzed 43 cases over the 8-week period. Median room setup time was 8.6 (IQR 4.7-16.3) minutes, and this was not significantly different based on the presence of hypotension (median 9.3 [IQR 4.7-16.3] vs. 6.1 [IQR 4.7-14.8] minutes, p =0.49). Overall equipment preparation rates were high, including anesthesia circuits (n=41, 97.6%), flushed IV tubing (n=40, 95.2%), and rapid transfuser availability (n=39, 92.9%). In contrast, we found opportunities for improvement in the preparation of other equipment, notably patient warmers (not prepared in 23.8% and video laryngoscopes (14.3%).
Conclusion:
Intraoperative trauma video review programs represent an exceptional opportunity to measure preparedness for emergent trauma surgical cases, an important aspect of trauma center quality. While we found that preparedness was excellent in some domains, we identified several important areas for improvement with respect to warming equipment. These insights will be used to inform future quality improvement action plans.