Quality of Documentation as a Surrogate Marker for Awareness and Training Effectiveness of PHTLS-Courses. Part of the Prospective Longitudinal Mixed-Methods EPPTC-Trial

Abstract

ObjectiveCare for severely injured patients requires multidisciplinary teamwork. A decrease in the number of accident victims ultimately affects the routine and skills. PHTLS (“Pre-Hospital Trauma Life Support”) courses are established two-day courses for medical and non-medical rescue service personnel, aimed at improving the pre-hospital care of trauma patients worldwide. The study aims the examination of the quality of documentation before and after PHTLS courses as a surrogate endpoint of training effectiveness and awareness.MethodsThis was a prospective pre-post intervention trial and was part of the mixed-method longitudinal EPPTC (Effect of Paramedic Training on Pre-Hospital Trauma Care) study, evaluating subjective and objective changes among participants and real patient care, as a result of PHTLS courses. The courses provide an overview of the SAMPLE approach for interrogation of anamnestic information, which is believed to be responsible for patient safety as relevant, among others, “Allergies,” “Medication,” and “Patient History” (AMP). The focus of the course is not the documentation.ResultsIn total, 320 protocols were analyzed before and after the training. The PHTLS course led to a significant increase (p < 0.001) in the “AMP” information in the documentation. The subgroups analysis of “allergies” (+47.2%), “drugs” (+38.1%), and “medical history” (+27.8%) before and after the PHTLS course showed a significant increase in the information content.ConclusionIn summary, we showed that PHTLS training improves documentation quality, which we used as a surrogate endpoint for learning effectiveness and awareness. In this regard, we demonstrated that participants use certain parts of training in real life, thereby suggesting that the learning methods of PHTLS training are effective. These results, however, do not indicate whether patient care has changed.

The pre-hospital care and the patient safety: contributions to the safe practice / O atendimento pré-hospitalar móvel e a segurança do paciente: contribuições para prática segura

“…20 Training with standardized programs such as PreHospital Trauma Life Support (PHTLS) is increasingly integrated into the preparation and adequate education of the prehospital emergency service team. 21 Training based on this protocol instructs the team to provide primary care for the trauma victim ensuring that other therapeutic measures are assessed later; maintaining security for staff and patients, and team communication with clear instructions and early identification of the receiving hospital, among others. 20 The quality of recording the care services, addressing the data and clinical history of the patient, is considered very relevant for maintaining patient safety.…”

ABCDE cognitive aid tool in patient assessment – development and validation in a multicenter pilot simulation study

“…Studies also stated that CA increase the safety of provided care [ 23 – 25 ]. Similarly, there is the parallel of our work with research focused on the impact of the Pre-Hospital Trauma Life Support training program on improving the quality of documentation in trauma [ 26 ]. This CA seems to be a promising tool to facilitate patient assessment in education and also in clinical practice.…”

Subjective safety and self-confidence in prehospital trauma care and learning progress after trauma-courses: part of the prospective longitudinal mixed-methods EPPTC-trial

“…Cognitive knowledge, technical skills and clinical judgment are the main pillars for healthcare providers [ 15 ]. The EPPTC-Trial investigates the impact of such courses and has shown that the trainings improve documentation quality, which was used as a surrogate endpoint for learning effectiveness and awareness [ 16 ]. It was demonstrated that participants used certain parts of training in real patient care, thereby suggested that the learning methods of prehospital trauma training are effective.…”

“…The present data showed this change only in the knowledge. The problem of knowledge verification by pre/post-test has already been discussed [ 16 ].…”