A quality-improvement approach to effective trauma team activation

Abstract

Background: Appropriate, timely trauma team activation (TTA) can directly affect outcomes for patients with trauma. A review of quality-performance indicators at our Canadian level 1 trauma centre showed a high level of undertriage, with TTA compliance rates less than 60% for major trauma. A quality-improvement project was undertaken, targeting a sustained goal of at least 90% TTA compliance based on Accreditation Canada guidelines. Methods: Quality-improvement action followed a well-defined process. Baseline data collection was performed, and, in keeping with the Donabedian approach, we brought together stakeholders to collectively review and understand the reasons behind poor TTA compliance; and root-cause analysis. This was followed by rapid change cycles that focused on structure and processes with ongoing audits to support and sustain change. Results: Trauma team activation compliance improved from 58.8% to more than 90% over 2 years. Quality indicators showed a statistically significant reduction in the time to computed tomography scanner, time in the acute care region of the emergency department and total time in the emergency department, with improved TTA compliance. Conclusion: Compliance with TTA protocols improved to more than 90% over a 2-year period, which shows the benefit of having a clearly outlined qualityimprovement process. This well-defined quality-improvement method provides a framework for use by other institutions that seek to improve their processes of trauma care, including activation rates. Contexte : Le déploiement rapide et approprié de l'équipe de traumatologie (DÉT) peut avoir une influence directe sur les résultats chez les polytraumatisés. Une revue des indicateurs de qualité/performance dans notre centre de traumatologie canadien de niveau 1 a révélé une lacune importante au plan du triage, et des taux de conformité aux protocoles de DÉT atteignant moins de 60 % pour les traumatismes majeurs. Un projet d'amélioration de la qualité a donc été entrepris avec pour objectif une conformité soutenue d'au moins 90 % aux protocoles de DÉT selon les lignes directrices d'Agrément Canada. Méthodes : Les mesures d'amélioration de la qualité ont suivi un processus bien défini. Une collecte des données de référence a été effectuée, et conformément au modèle de Donabedian, nous avons réuni les différentes parties intéressées pour revoir et comprendre ensemble les raisons de la piètre conformité aux protocoles de DÉT et procéder à leur analyse en profondeur. On a ensuite appliqué des cycles de changements rapides axés sur la structure et les procédés, accompagnés de vérifications en continu pour les appuyer et les maintenir. Résultats : La conformité aux protocoles de déploiement de l'équipe de traumatologie s'est améliorée, passant de 58,8 % à plus de 90 % en l'espace de 2 ans. Les indicateurs de qualité ont montré des réductions statistiquement significatives du délai prétomographie, du temps passé dans la section de soins aigus du service des urgences et du temps total passé aux urgences, de m...

Time Delay in Motor Vehicle Accident Arrival: A Critical Analysis of Trauma Team Activation

“…For instance, a Canadian level I trauma center implemented a quality improvement project to enhance TTA compliance, achieving an improvement from 58.8% to over 90%. This success highlights the benefits of a well-defined qualityimprovement process in achieving sustained improvements in TTA compliance and subsequent trauma care processes [14].…”

A profile of a major trauma centre of North West England between 2011 and 2018

“…This study demonstrates that improved quality of trauma care in a new MTC is not a straightforward linear process 27,28 . The key message is that the measured annual observed and expected mortality and survival rates varied considerably between 2011 and 2018, with an unexpected surge in mortality observed in 2012 immediately following the launch of the Major Trauma Centre Collaborative in Merseyside and Cheshire, North West England.…”

Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after study

“…However, presenting the criteria in a dropdown menu format offers consistent visual repetition, which enhances memory and retention of the criteria. Previous research has shown that compliance with guidelines in various clinical settings can be improved by making the guidelines more accessible, simplifying them, and optimizing team efficiency and education [18][19][20][21][22]. Therefore, it is likely that both the dropdown menu modification and the dispatcher-driven system contributed to the overall improvement in compliance.…”

“…Compliance with a specific institution's clinical guidelines for TTA is shaped by a complex interplay of numerous factors. These include the quantity and complexity of the guidelines [18,19], the ease of referencing criteria within the workspace [20], the number of staff members involved in implementing the criteria [21], staff education about the criteria [22], and feedback loops for staff regarding clinical performance [20,23]. The influence of human factors, educational infrastructure, and the institutional team culture cannot be overstated.…”