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Related Experiment Videos

An objective analysis of process errors in trauma resuscitations.

J R Clarke1, B Spejewski, A S Gertner

  • 1Department of Surgery, MCP-Hahnemann University, Philadelphia, PA 19129, USA. jclarke@gradient.cis.upenn.edu

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|November 10, 2000
PubMed
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A validated computer system revealed reasoning errors in all trauma resuscitation cases. Most errors involved omissions and failure to document relevant information, though few were linked to adverse outcomes.

Area of Science:

  • Medical Informatics
  • Trauma Surgery
  • Clinical Decision Support

Background:

  • Trauma resuscitation protocols are critical for managing penetrating thoracoabdominal injuries.
  • A computer-based system for applying these protocols was previously validated.
  • Objective critique of clinical reasoning in trauma care is essential for quality improvement.

Purpose of the Study:

  • To describe the application of a validated computer system for objectively critiquing trauma resuscitation care.
  • To identify and classify process errors in clinical reasoning for patients with penetrating thoracoabdominal trauma.
  • To evaluate reasoning errors independently of patient outcomes.

Main Methods:

  • A chronological narrative of patient care was input into a computer program.

Related Experiment Videos

  • Actual patient care was compared against validated computer protocols at decision points.
  • Differences were classified as critical/noncritical errors of commission, omission, or procedure selection using a scoring system.

    • Main Results:

    • Reasoning errors occurred in 100% of the 97 cases studied, averaging 11.9 per case.
    • Errors of omission were more frequent (2.4/case) and severe (19.4/error) than errors of commission (1.2/case, 5.1/error).
    • The most common error was the failure to record or consider relevant information (7.4 missing items/patient).

    Conclusions:

    • Process errors in clinical reasoning are ubiquitous in trauma resuscitation, present in every case.
    • Errors of omission were more severe and prevalent than errors of commission.
    • Failure to consider or document available relevant information was the most frequent reasoning error.