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Trauma Quality Improvement: Reducing Triage Errors by Automating the Level Assignment Process.

David P Stonko1, Dillon C O Neill1, Bradley M Dennis2

  • 1Vanderbilt University School of Medicine, Nashville, Tennessee.

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|April 17, 2018
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Summary

A quality improvement project successfully reduced trauma triage errors by over 50% using a novel web tool and protocol refinement. This initiative improved accuracy in trauma activation protocols, benefiting patient outcomes.

Keywords:
Interpersonal and Communication SkillsMedical KnowledgePatient CarePractice-Based Learning and ImprovementSystems-Based Practiceleveling errormedical student educationprotocol adherencequality improvementtrauma process improvementtriage error

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Area of Science:

  • Emergency Medicine
  • Trauma Care
  • Quality Improvement

Background:

  • Trauma patient triage relies on institution-specific protocols, which often suffer from imperfect adherence, leading to undertriage or overtriage.
  • Optimizing trauma activation protocols is crucial for improving patient outcomes and care efficiency.
  • This quality improvement (QI) project aimed to enhance adherence to trauma triage protocols and reduce errors.

Purpose of the Study:

  • To improve adherence to trauma activation protocols.
  • To reduce triage errors (undertriage and overtriage) in trauma patients.
  • To develop and test a sustainable quality improvement framework for trauma triage.

Main Methods:

  • A quality improvement team implemented two sequential Plan-Do-Study-Act (PDSA) cycles.
  • The first PDSA cycle involved developing and implementing a web tool to automate trauma level assignment based on existing protocols.
  • The second PDSA cycle focused on refining triage accuracy for specific injury types, such as burns, with ongoing data review and run chart analysis.

Main Results:

  • The combined trauma triage error rate decreased by over 50%, from 16.7% at baseline to 7.9% after the second PDSA cycle.
  • Implementation of the web tool significantly reduced overtriage (from 27 to 13 patients) and combined errors (p = 0.017).
  • Overtriage further decreased to 10 patients after protocol refinement, with no significant change in undertriage rates.

Conclusions:

  • A combination of a web tool and protocol refinement effectively decreased combined trauma triage errors by over 50%.
  • The developed web tool demonstrated improved triage accuracy and offered a sustainable method for future quality improvement initiatives.
  • The QI framework and web tool are designed for easy expansion to other healthcare institutions.