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Closed-Loop Communication Improves Task Completion in Pediatric Trauma Resuscitation
Ibrahim Abd El-Shafy1, Jennifer Delgado2, Meredith Akerman3
1Department of Surgery, Hofstra Northwell School of Medicine, Cohen Children׳s Medical Center, New Hyde Park, New York; Feinstein Institute for Medical Research, Manhasset, New York; Department of Surgery, Maimonadies Medical Center, Brooklyn, New York.
Insights
Closed-loop communication significantly speeds up task completion in pediatric trauma resuscitation. Implementing these communication strategies in trauma team training can improve efficiency and patient care.
Area of Science:
- Medical Communication
- Trauma Care
- Patient Safety
Background:
- Effective communication is critical in time-sensitive pediatric trauma care.
- Aviation and healthcare have adopted structured communication strategies (e.g., TeamSTEPPS) to prevent errors.
- Closed-loop communication, a key component of structured communication, warrants evaluation in pediatric trauma settings.
Purpose of the Study:
- To evaluate the impact of closed-loop communication on time-to-task completion during pediatric trauma activations.
- To assess whether pre-notification or activation level influences task completion times.
Main Methods:
- Prospective observational study of 89 pediatric trauma activations.
- Video recording and independent review of verbal orders for audibility, directed responsibility, and check-back.
- Analysis of time-to-task completion, pre-notification, and activation level using SAS 9.4.
Main Results:
- 387 verbal orders were analyzed; 26.1% utilized closed-loop communication.
- Closed-loop communication significantly reduced time-to-task completion (p < 0.0001), with orders completed 3.6 times faster.
- Pre-notification and trauma team activation level did not significantly impact time-to-task completion.
Conclusions:
- Closed-loop communication enhances efficiency in pediatric trauma resuscitation.
- Training programs for trauma team leaders should incorporate closed-loop communication strategies.
- Implementing structured communication can improve the speed and effectiveness of pediatric trauma care.
Background:
Pediatric trauma care requires effective and clear communication in a time-sensitive manner amongst a variety of disciplines. Programs such as Crew Resource Management in aviation have been developed to systematically prevent errors. Similarly, teamSTEPPS has been promoted in healthcare with a strong focus on communication. We aim to evaluate the ability of closed-loop communication to improve time-to-task completion in pediatric trauma activations.
Methods:
All pediatric trauma activations from January to September, 2016 at an American College of Surgeons verified level I pediatric trauma center were video recorded and included in the study. Two independent reviewers identified and classified all verbal orders issued by the trauma team leader for order audibility, directed responsibility, check-back, and time-to-task-completion. The impact of pre-notification and level of activation on time-to-task-completion was also evaluated. All analyses were performed using SAS® version 9.4(SAS Institute Inc., Cary, NC).
Results:
In total, 89 trauma activation videos were reviewed, with 387 verbal orders identified. Of those, 126(32.6%) were directed, 372(96.1%) audible, and 101(26.1%) closed-loop. On average each order required 3.85 minutes to be completed. There was a significant reduction in time-to-task-completion when closed-loop communication was utilized (p < 0.0001). Orders with closed-loop communication were completed 3.6 times sooner as compared to orders with an open-loop [HR = 3.6 (95% CI: 2.5, 5.3)]. There was not a significant difference in time-to-task-completion with respect to pre-notification by emergency service providers (p < 0.6100). [HR = 1.1 (95% CI: 0.9, 1.3)]. There was also not a significant difference in time-to-task-completion with respect to level of trauma team activation (p < 0.2229). [HR = 1.3 (95% CI: 0.8, 2.1)].
Conclusion:
While closed-loop communication prevents medical errors, our study highlights the potential to increase the speed and efficiency with which tasks are completed in the setting of pediatric trauma resuscitation. Trauma drills and systems of communication that emphasize the use of closed-loop communication should be incorporated into the training of trauma team leaders.
Level Of Evidence:
This is a prospective observational study with intervention level II evidence.
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