Introduction of a mobile device based tertiary survey application reduces missed injuries: A multi-center prospective study

Moffat, Bradford A.; Vogt, Kelly; Inaba, Kenji; Δημητριάδης, Δημήτριος; Martin, Cody L.; Malthaner, Richard; Gray, Daryl; Parry, Neil

doi:10.1016/j.injury.2019.08.020

Cited by 4 publications

(1 citation statement)

References 20 publications

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“…Such a systematic approach is especially important as the initial period of trauma care can be chaotic with a high propensity for errors. Majority of the literature documenting process of trauma care comes from high-income countries [2,[6][7][8][9][10]. Less is known about the status of process of care for the injured and the extent to which a systematic approach is employed in their initial assessment at LMIC hospitals.…”

Section: Introductionmentioning

confidence: 99%

Achievement of Key Performance Indicators in Initial Assessment and Care of Injured Patients in Ghanaian Non‐tertiary Hospitals: An Observational Study

et al. 2022

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Introduction We aimed to determine the level of achievement of key performance indicators (KPIs) during initial assessment and management of injured persons, as assessed by independent observers, at district and regional hospitals in Ghana. Methods Trained observers were stationed at emergency units of six district (first level) and two regional (referral) hospitals, from October 2020 to February 2021, to observe management of injured patients by health service providers. Achievement of KPIs was assessed for all injured patients and for seriously injured patients (admitted for C 24 h, referred, or died). Results Management of 1006 injured patients was observed. Road traffic crash was the most common mechanism (63%). Completion of initial triage ranged from 65% for oxygen saturation to 92% for mobility assessment. For primary survey, airway was assessed in 77% of patients, chest examination performed in 66%, and internal abdominal bleeding assessed in 43%. Reassessment rates were low, ranging from 16% for respiratory rate to 23% for level of consciousness. Thirty-one percent of patients were seriously injured. Completion of KPIs was higher for these patients, but reassessment remained low, ranging from 25% for respiratory rate to 33% for level of consciousness. Conclusion KPIs were performed at a high level, but several specific elements should be performed more frequently, such as oxygen saturation and assessment for internal abdominal bleeding. Reassessment needs to be performed more frequently, especially for seriously injured patients. Overall, care for the injured at non-tertiary hospitals in Ghana could be improved with a more systematic approach.

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Section: Introductionmentioning

confidence: 99%

Achievement of Key Performance Indicators in Initial Assessment and Care of Injured Patients in Ghanaian Non‐tertiary Hospitals: An Observational Study

et al. 2022

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The Clinical Decision Support System for Trauma Emergency Care: Development, Modification and Clinical Use (Preprint)

Jian¹,

Lv²,

Ao³

et al. 2021

Preprint

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BACKGROUND Background: Trauma remains an urgent social problem as the leading cause of death in persons 1 through 44 years of age. According Computerized clinical decision support system (CDSS) is a solution to promote Advanced trauma Life Support (ATLS) protocol for traumatic emergency management. OBJECTIVE Objectives: The objectives were to develop a CDSS for trauma management in emergency department (ED) based on ATLS algorithm, and evaluate its preliminary effectiveness for the treatment of patients admitted to the emergency room (ER) suffering from severe injuries. METHODS Methods: A design workshop was convened to discuss the goals and users’ needs of a CDSS based on ATLS algorithm and then worked through typical clinical scenarios involving trauma emergency. The prototype CDSS was developed and then refined based on scenarios in ED involving multiple injuries. field testing was conducted to point out the defects of the system's function in real clinical environment and further optimize it. A comparation of clinical outcomes before and after the implement of the CDSS was conducted to evaluate the effectiveness of the CDSS. RESULTS Results: A common design concept of Trauma First Aid (TFA) emerged after three rounds of discussions and storyboard design. Some bugs during the use process were fixed after case-based refinement. The CDSS workstations were divided into mobile terminals with a pad and medical workbenches with an all-in-one computer. Application programming interface (API) to get real-time access to electronic health record system and online specialist consultation were achieved by the CDSS after field testing. In the clinical study, a total of 176 consecutive trauma patients with a complete TFA file between June 2020 and June 2021 were compared with 235 traumatic patients in ER before the implement of TFA from June 2018 to June 2019. The missed injury rate dropped from 11% to 4% (p < 0.01) after the implement of TFA. Time duration from admission to physician's first order was longer in the TFA group (21±11min vs 11±13min ,p< 0.01). There was a higher rate of packed RBCs transfusions (69% vs 43%, p < 0.01) with less time duration from admission to the order of blood transfusion (35±37min vs 50±33min, p<0.05) in TFA group when compared with the control group. The consultation time of relevant department was much shorter in the TFA group (10±17min vs 25±33min, p<0.01). CONCLUSIONS Conclusions: TFA was a CDSS based on ATLS algorithm and assisted clinical decision for physicians in the ED to treat traumatic patients in the advanced life support stage. The initial clinical evaluation in a reginal trauma center showed practicality and effectiveness of the CDSS.

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Time to improve documentation of neonatal resuscitation: a narrative review

et al. 2023

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Introduction of a mobile device based tertiary survey application reduces missed injuries: A multi-center prospective study

Cited by 4 publications

References 20 publications

Achievement of Key Performance Indicators in Initial Assessment and Care of Injured Patients in Ghanaian Non‐tertiary Hospitals: An Observational Study

Achievement of Key Performance Indicators in Initial Assessment and Care of Injured Patients in Ghanaian Non‐tertiary Hospitals: An Observational Study

The Clinical Decision Support System for Trauma Emergency Care: Development, Modification and Clinical Use (Preprint)

Time to improve documentation of neonatal resuscitation: a narrative review

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