TY - JOUR
T1 - Getting out of the bay faster
T2 - Assessing trauma team performance using trauma video review
AU - Maiga, Amelia W.
AU - Vella, Michael A.
AU - Appelbaum, Rachel D.
AU - Irlmeier, Rebecca
AU - Ye, Fei
AU - Holena, Daniel N.
AU - Dumas, Ryan P.
AU - Erickson, Caroline R.
AU - Dennis, Brad M.
AU - Da Luz, Luis T.
AU - Pannell, Dylan
AU - Quigley, Emily
AU - Velopulos, Catherine G.
AU - Hendzlik, Peter
AU - Marinica, Alexander
AU - Bruce, Nolan
AU - Margolick, Joseph
AU - Butler, Dale F.
AU - Estroff, Jordan
AU - Zebley, James A.
AU - Alexander, Ashley
AU - Mitchell, Sarah
AU - Grossman Verner, Heather M.
AU - Truitt, Michael
AU - Berry, Stepheny
AU - Middlekauff, Jennifer
AU - Luce, Siobhan
AU - Leshikar, David
AU - Krowsoski, Leandra
AU - Bukur, Marko
AU - Polite, Nathan M.
AU - McMann, Ashley H.
AU - Staszak, Ryan
AU - Armen, Scott B.
AU - Horrigan, Tiffany
AU - Moore, Forrest O.
AU - Bjordahl, Paul
AU - Guido, Jenny
AU - Mathew, Sarah
AU - Diaz, Bernardo F.
AU - Mooney, Jennifer
AU - Hebeler, Katherine
N1 - Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - 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.
AB - 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.
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U2 - 10.1097/TA.0000000000004168
DO - 10.1097/TA.0000000000004168
M3 - Article
C2 - 37880840
AN - SCOPUS:85180003338
SN - 2163-0755
VL - 96
SP - 76
EP - 84
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1
ER -