Optimizing Trauma Care: Evaluating Operating Room Door-to-Incision Using Trauma Video Review

Rapid hemorrhage control is a critical determinant of survival in trauma patients, with time to surgical incision playing a significant role in outcomes. Operating room door-to-incision time (orDTI) is a novel metric for assessing preoperative efficiency. We hypothesized that hemodynamically unstable patients, defined by systolic blood pressure ≤90 mmHg or massive transfusion protocol (MTP) activation, would have shorter orDTI. This study aimed to quantify orDTI using video review, evaluate contributing factors, and identify potential quality improvement opportunities.

A prospective analysis of emergent trauma operations was conducted at our Level 1 trauma center between June 19, 2024, and August 13, 2024. High-fidelity video recordings of the trauma operating room (OR) were used to document preincision activities. Data on timing, type, and success of procedures performed before incision were abstracted. The primary outcome was orDTI, defined as the time from OR arrival to surgical incision. Secondary outcomes included orDTI comparisons between physiologically stable and unstable patients.

Forty-two trauma operations were reviewed, of which 33 (78%) involved a penetrating mechanism. The median orDTI was 17.0 min (interquartile range (IQR) 15.6-20.1). MTP was activated in 36% of cases, and 43% of patients exhibited hypotension by incision time. No significant difference in orDTI was observed between patients with activated MTP (16.5 versus 17.2 min, P = 0.53) or preincision hypotension (17.2 versus 16.7 min, P = 0.40).

The orDTI metric is valuable for evaluating trauma care efficiency. Despite physiological instability, orDTI remained consistent, highlighting opportunities to improve workflows and team coordination to reduce delays to hemorrhage control.