Flow Disruptions in Trauma Surgery: Type, Impact, and Affect

Abstract

The objective of this study was to identify and understand all components of the trauma care process to mitigate the systemic challenges faced by clinicians attempting to deliver the best trauma care. The study was conducted using a prospective data collection method. An interdisciplinary team of researchers observed 87 cases over a 10-week period and identified 1759 flow disruptions. There were a higher number of flow disruptions per case in the operating room (M=61.3, ±36.72) than in the emergency department (M=9.2, ±1.77) or radiology (M=7.5, ±2.01). Focusing on the OR, the majority of the flow disruptions identified in the OR were due to either coordination issues (28%) or communication breakdowns (24%). Roughly 12% of disruptions resulted in moderate delays or full case cessation. This study demonstrates the value of using flow disruptions as a surrogate for efficiency and quality outcome measures, and as a diagnostic method for understanding higher order problems in the system of trauma care.

Do resident's leadership skills relate to ratings of technical skill?

“…Similar results were found in a review of communication skills and error frequency [5]. Improved communication and leadership amongst those on a surgical team increases effectiveness in the operating room by decreasing operative time and improving patient safety [6][7][8][9].…”

“…While it may seem that non-technical skills are only complementary to technical skills, clinical residency training should also focus on teaching non-technical skills because of the benefits demonstrated intraoperatively [4][5][6][7][8][9]. However, non-technical skills can be harder to assess [10] and are commonly minimized in training [11].…”

A Markov chain approach to study flow disruptions on surgery in emergency care

“…A total of 1759 flow disruptions are identified across 87 trauma cases during a tenweek period. For each disruption, the start and end time of the surgery, the disruption's start and end time, the disruption type, etc., are recorded [3]. Based on this information, an analytical model has been developed.…”

“…The disruptions during surgery are classified into 10 types according to the reasons of occurrence ( [3]). These types are referred to as types 1 to 10 (corresponding to states 1 to 10) in this study, as shown in Table I.…”

A Comprehensive Methodology for Examining the Impact of Surgical Team Briefings and Debriefings on Teamwork

“…Timeline of the comprehensive methodology Table 1. Event categorization by type and impact (Blocker et al, 2010;Blocker et al, 2012;Parker et al, 2010) Type Definition Communication Any breach or lapse in team cooperativeness, cohesion, and/or familiarity as a result of verbal information exchanged (e.g. misunderstanding, communication unheard, case-related communication, extraneous conversation) Coordination Any breach or lapse in team cooperativeness, cohesion, and/or familiarity as a result of poor organization function (e.g.…”