P044: Outcomes of direct observation of trauma resuscitation

Abstract

Introduction: Trauma resuscitations are sporadic high acuity situations that can be difficult to assess for areas of quality improvement. We aim to analyse the type of observation that occurs during trauma resuscitations and outcomes that develop as a result. Methods: Medline was searched from 1946 to May 2019 for studies involving direct observation of trauma resuscitation. English studies of both adult and pediatric populations from 2000 onwards were included for study. They were compared for type of observation (in-person vs video) as well as primary outcomes of their observation and any quality improvement as a result. Results: A total of 413 publications were identified with 10 meeting eligibility for inclusion. All 10 studies underwent video review with no in-person review being performed. The most common primary outcome was analysis of a critical procedure (6 studies), with tracheal intubation being studied in 4 studies and thoracotomy and vascular access each being studied once. The remaining studies measured communication styles and team effectiveness. Overall 5 of the 10 studies resulted in new policies being put in place for trauma resuscitations, including; use of interosseous lines as first lines in trauma patients in extremis, tracheal intubation check list, and continuing with medical student participation in cardiopulmonary resuscitation. Conclusion: This study highlights some of the common focuses of trauma resuscitation observation; critical procedures, team dynamics and communication. A majority of studies focused on critical procedures during resuscitations and quality improvement in the form of checklists to improve them. Remaining studies focused on equally important aspects of team functioning and communication which can be more difficult to objectively measure and derive quality improvement measures for. These studies led an emphasis on use of a horizontal assessment style and closed loop communication in all their trauma resuscitation.