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Focused Assessment with Sonography for Trauma FAST Exam: Image Acquisition
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A "High-Reliability Organization" Approach to Improve Trauma Imaging Performance.

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  • 1Associate Director of Service, Department of Radiology, Denver Health, Denver, Colorado.

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Summary

A high-reliability organization (HRO) approach significantly reduced computed tomography (CT) turnaround times for trauma patients by implementing targeted interventions. This culture-focused strategy proved effective in improving CT performance for critically ill individuals.

Keywords:
High reliability organization (HRO)collegial interactive team (CIT)computed tomography (CT)emergency department (ED)turnaround times (TATs)

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Area of Science:

  • Radiology
  • Healthcare Management
  • Quality Improvement

Background:

  • Computed tomography (CT) is crucial for trauma patient triage, with increasing utilization.
  • Improving CT turnaround times (TATs) is a common goal in critical care settings.
  • Traditional improvement methods like Lean and Six Sigma differ from High-Reliability Organization (HRO) approaches.

Purpose of the Study:

  • To evaluate a High-Reliability Organization (HRO) model for rapid improvement of trauma patient CT performance.
  • To assess the HRO approach's ability to generate, trial, select, and implement interventions.
  • To measure the impact of HRO-driven interventions on CT turnaround times in trauma care.

Main Methods:

  • A 5-month study included all trauma patients at a single institution.
  • Interventions were developed and implemented over a 3-month period (1-month wash-in, 2-month postintervention).
  • Job briefs were used to ensure shared understanding and facilitate idea generation among staff.

Main Results:

  • Seven interventions were implemented, including text alerts, scripted communication, and modified CT protocols.
  • Median CT TATs for trauma patients decreased by 60% (from 78 to 31 minutes).
  • The observed reduction in TATs was statistically significant (P < .001).

Conclusions:

  • The HRO approach facilitated rapid development and implementation of improvement interventions.
  • The implemented interventions effectively and substantially decreased trauma patient CT TATs.
  • An HRO model offers a viable strategy for enhancing CT performance in trauma care.