Getting out of the bay faster: Assessing trauma team performance using trauma video review

Amelia W. Maiga, Michael A. Vella, Rachel D. Appelbaum, Rebecca Irlmeier, Fei Ye, Daniel N. Holena, Ryan P. Dumas, Caroline R. Erickson, Brad M. Dennis, Luis T. Da Luz, Dylan Pannell, Emily Quigley, Catherine G. Velopulos, Peter Hendzlik, Alexander Marinica, Nolan Bruce, Joseph Margolick, Dale F. Butler, Jordan Estroff, James A. ZebleyAshley Alexander, Sarah Mitchell, Heather M. Grossman Verner, Michael Truitt, Stepheny Berry, Jennifer Middlekauff, Siobhan Luce, David Leshikar, Leandra Krowsoski, Marko Bukur, Nathan M. Polite, Ashley H. McMann, Ryan Staszak, Scott B. Armen, Tiffany Horrigan, Forrest O. Moore, Paul Bjordahl, Jenny Guido, Sarah Mathew, Bernardo F. Diaz, Jennifer Mooney, Katherine Hebeler

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND Minutes matter for trauma patients in hemorrhagic shock. How trauma team function impacts time to the next phase of care has not been rigorously evaluated. We hypothesized better team performance scores to be associated with decreased time to the next phase of trauma care. METHODS This retrospective secondary analysis of a prospective multicenter observational study included hypotensive trauma patients at 19 centers. Using trauma video review, we analyzed team performance with the validated Non-Technical Skills for Trauma scale: leadership, cooperation and resource management, communication, assessment/decision making, and situational awareness. The primary outcome was minutes from patient arrival to next phase of care; deaths in the bay were excluded. Secondary outcomes included time to initiation and completion of first unit of blood and inpatient mortality. Associations between team dynamics and outcomes were assessed with a linear mixed-effects model adjusting for Injury Severity Score, mechanism, initial blood pressure and heart rate, number of team members, and trauma team lead training level and sex. RESULTS A total of 441 patients were included. The median Injury Severity Score was 22 (interquartile range, 10-34), and most (61%) sustained blunt trauma. The median time to next phase of care was 23.5 minutes (interquartile range, 17-35 minutes). Better leadership, communication, assessment/decision making, and situational awareness scores were associated with faster times to next phase of care (all p < 0.05). Each 1-point worsening in the Non-Technical Skills for Trauma scale score (scale, 5-15) was associated with 1.6 minutes more in the bay. The median resuscitation team size was 12 (interquartile range, 10-15), and larger teams were slower (p < 0.05). Better situational awareness was associated with faster completion of first unit of blood by 4 to 5 minutes (p < 0.05). CONCLUSION Better team performance is associated with faster transitions to next phase of care in hypotensive trauma patients, and larger teams are slower. Trauma team training should focus on optimizing team performance to facilitate faster hemorrhage control. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.

Original languageEnglish (US)
Pages (from-to)76-84
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume96
Issue number1
DOIs
StatePublished - Jan 1 2024

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

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