Flow disruptions during trauma care

Area of Science:

• Trauma Care Research
• Patient Safety
• Healthcare Systems Analysis

Background:

• Flow disruptions (FDs) are deviations in care progression impacting safety and efficiency.
• The frequency and causes of FDs in trauma care are not well-documented.
• This study quantifies FDs across different phases of trauma care.

Purpose of the Study:

• To identify and quantify the rate of flow disruptions (FDs) during trauma care.
• To analyze the causes of FDs, including communication, coordination, environmental, and patient factors.
• To establish a baseline for improving trauma care processes.

Main Methods:

• Direct observational study of 86 trauma cases at a Level I trauma center over 2 months.
• Trained observers used a validated Tablet-PC tool to record FDs and work-system variables.
• Data collected across trauma bay, imaging (CT), and operating room (OR) phases.

Main Results:

• A total of 1,759 FDs were recorded (20.4 FDs per case).
• High-level trauma activations had significantly more FDs than low-level activations.
• The operating room (OR) and computed tomography (CT) phases showed the highest FD rates, primarily due to coordination breakdowns.

Conclusions:

• This is the largest direct observational study of the trauma process to date.
• Complexities in critical trauma patient care lead to frequent disruptions, particularly related to coordination.
• Prospective observation can identify systemic deficiencies, enabling targeted interventions to streamline trauma care.