Background Major Trauma Care is complex and requires robust communication systems between multidisciplinary teams. At Nottingham University Hospitals, major trauma patients requiring emergency surgery are prioritised in theatres creating competition for resources. This requires the Theatre Coordinator receiving appropriate patient information from the Emergency Department to determine the surgical urgency. We aimed to evaluate the existing theatre booking process for major trauma patients, identify key problems in practice, and redesign and test any new system prior to implementation.
Methodology A literature review, analysis of existing major trauma care activity and historical local incident reports helped identify potential or actual system problems. Fieldwork enabled observation of the booking process in practice. A questionnaire and focus groups were used to explore existing practices and inform any redesign by consensus amongst an expert panel. Testing this new tool was initiated using simple desktop based simulation exercises.
Results The literature and local data described clear consequences of failure to provide adequate patient information in a time critical manner. An existing major trauma theatre booking form was found to be used infrequently and inconsistently, with Co-ordinators favouring a more familiar generic form. Questionnaire data and focus groups with theatre staff, surgeons and anaesthetists (n = 84) distinguished critical versus surplus information for theatre planning, enabling redesign of the form, structured using key information in a chronological systematic manner.
Next Steps The new form is now being tested using desktop simulations based on real cases with theatre coordinators, comparing useability and accuracy of data transmission with the generic form. This will guide further modifications before trialling it in practice. Further steps anticipated include production of a standardised handover proforma to be implemented in the Emergency Department, and evaluation of whether the final theatre booking form also provides a team briefing tool for when the patient arrives in theatres.
Flin R, O’Connor P, Chrichton M. Safety at the Sharp End. A guide to non-technical skills. Burlington: Ashgate Publications; 2012
Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork in providing safe care. Qual Saf Healthcare 2004;13, 85–90
Barach P, Weinger MB. Trauma team performance. Wilson WC, Grande CM, Editors: TRAUMA : Resuscitation, Anesthesia and Emergency Surgery. Chapter 6. Taylor and Francis: NewYork, pp. 101–13, 2007
MCCulloch, Rathbone, & Catchpole, 2011. Inteventions to improve teamwork and communications among healthcare. British Journal of Surgery, 98, 469–479
- Category: Course or curriculum evaluation/innovation/integration
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.