Colin F Mackenzie1, Stacy A Shackelford2, Samuel A Tisherman3, Shiming Yang4, Adam Puche5, Eric A Elster6, Mark W Bowyer6. 1. Shock Trauma Anesthesiology Research, University of Maryland School of Medicine, Baltimore, MD. Electronic address: cmack003@gmail.com. 2. Joint Trauma System, Defense Center of Excellence for Trauma, San Antonio, TX. 3. Shock Trauma Anesthesiology Research, University of Maryland School of Medicine, Baltimore, MD; Department of Surgery, University of Maryland School of Medicine, Baltimore, MD. 4. Shock Trauma Anesthesiology Research, University of Maryland School of Medicine, Baltimore, MD. 5. Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD. 6. Department of Surgery, Uniformed Services University of Health Sciences, and the Walter Reed National Military Medical Center, Bethesda, MD.
Abstract
BACKGROUND: Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors. METHODS: In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts. RESULTS: Resident trauma readiness index increased with training (P < .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P < .05). Expert trauma readiness index was higher than residents (P < .004) and practicing surgeons (P < .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error. CONCLUSION: Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention. Crown
BACKGROUND: Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors. METHODS: In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts. RESULTS: Resident trauma readiness index increased with training (P < .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P < .05). Expert trauma readiness index was higher than residents (P < .004) and practicing surgeons (P < .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error. CONCLUSION: Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention. Crown
Authors: Colin F Mackenzie; Shiming Yang; Evan Garofalo; Peter Fu-Ming Hu; Darcy Watts; Rajan Patel; Adam Puche; George Hagegeorge; Valerie Shalin; Kristy Pugh; Guinevere Granite; Lynn G Stansbury; Stacy Shackelford; Samuel Tisherman Journal: World J Surg Date: 2021-01-03 Impact factor: 3.352