Trauma Dictations in the Emergency Department: A Quality Improvement/Patient Safety Project

Trauma patients frequently represent a unique and challenging patient population in emergency medicine care settings. The policy of the McLaren Oakland Emergency Department (ED) is to have the treatment of all Level 1 and Level 2 trauma activations dictated by the ED resident. This policy is intended to facilitate both patient safety through clear communication between multiple medical services and quality improvement through reporting trauma specific quality metrics to third party agencies. Despite this requirement, trauma dictations in this setting were often found to not be completed. The purpose of this quality improvement/patient safety project was to implement a trauma dictation template to increase the rate of completed ED trauma dictations to above 75% of all Level 1 and Level 2 trauma activations.

A trauma dictation template was created to aid ED residents while completing trauma dictations. It was thought by the authors that the implementation of a standardized dictation template would help residents specify the necessary components needed to improve both patient safety and quality reporting. The development of the template was a collaborative effort between the emergency medicine residents and faculty, the trauma coordinator and trauma surgeons. The project was evaluated using two separate measures. A "process measure" was first used to determine if the addition of the trauma template made dictating less burdensome for ED residents, and an "outcomes measure" helped the authors examine whether template implementation actually led to an increased rate in completed trauma dictation.

Data were collected during a three-month period prior to template implementation and three months after implementation. From November, 2015 through April, 2016, a total of 132 Trauma Activations were reviewed. The rate of completed dictations on Level 1 trauma activations increased from 45.16% to 53.33%. However, the rate of dictations on Level 2 trauma activations decreased from 50% to 30.4%, suggesting that Level 1 trauma patient care may have derived greater improvements from the new dictation template.

The results of the ED residents' evaluative survey responses were generally positive, indicating that the trauma template was perceived by most residents as a useful tool to complete dictations. Even though the outcome goal was not achieved, the project successfully achieved the goal of creating and implementing a usable trauma dictation template. Following the Plan-Do-Study-Act model for quality improvement/patient safety projects, the next project will examine additional barriers preventing users from utilizing this initial well-received tool.