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Flow disruptions during trauma care.

Daniel Shouhed1, Renaldo Blocker, Alex Gangi

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Flow disruptions (FDs) in trauma care are frequent, especially during high-level activations and in the operating room. Breakdowns in coordination are the leading cause, impacting patient safety and efficiency.

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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.