Alice Gray1,2,3, Lucas B Chartier1,2, Katerina Pavenski4,5, Melissa McGowan3, Gerald Lebovic6,7, Andrew Petrosoniak8,9. 1. Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Canada. 2. Department of Emergency Medicine, University Health Network, Toronto, Canada. 3. Department of Emergency Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. 4. Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Canada. 5. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. 6. Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada. 7. Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. 8. Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Canada. petro82@gmail.com. 9. Department of Emergency Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. petro82@gmail.com.
Abstract
INTRODUCTION: Massive hemorrhage protocols are widely used to facilitate the administration of blood components to bleeding trauma patients. Delays in this process are associated with worse patient outcomes. We used in situ simulation as a novel and iterative quality improvement technique to reduce the mean time between massive hemorrhage protocol activation and blood administration during actual trauma resuscitations. METHODS: We completed monthly, risk-informed unannounced in situ trauma simulations at a Canadian Level 1 trauma centre. We identified three major latent safety threats: (1) massive hemorrhage protocol activation; (2) transport of blood components; and (3) situational awareness of team members. Process improvements for each latent safety threats were tested and implemented during subsequent in situ simulation sessions. We evaluated the effect of this simulation-based intervention on the care of patients before, during and after the intervention. Demographic, clinical and massive hemorrhage protocol data were collected. The primary outcome was mean time between massive hemorrhage protocol activation and blood administration during actual trauma resuscitations as analyzed using a two-sample t test. RESULTS: Each group was similar in demographic and injury characteristics. The time from massive hemorrhage protocol activation to blood administration decreased from 11.6 min pre-intervention to 9.1 min post-intervention. This represented a significant reduction (2.5 min, 95% confidence interval, 0.03-5.08) following the in situ simulation-based quality improvement intervention. CONCLUSIONS: A comprehensive, in situ simulation-based quality improvement project was associated with a significant reduction in the mean time between massive hemorrhage protocol activation and blood administration among injured patients. In situ simulation represents a novel approach to the identification and mitigation of latent safety threats during massive hemorrhage protocol activation.
INTRODUCTION: Massive hemorrhage protocols are widely used to facilitate the administration of blood components to bleeding traumapatients. Delays in this process are associated with worse patient outcomes. We used in situ simulation as a novel and iterative quality improvement technique to reduce the mean time between massive hemorrhage protocol activation and blood administration during actual trauma resuscitations. METHODS: We completed monthly, risk-informed unannounced in situ trauma simulations at a Canadian Level 1 trauma centre. We identified three major latent safety threats: (1) massive hemorrhage protocol activation; (2) transport of blood components; and (3) situational awareness of team members. Process improvements for each latent safety threats were tested and implemented during subsequent in situ simulation sessions. We evaluated the effect of this simulation-based intervention on the care of patients before, during and after the intervention. Demographic, clinical and massive hemorrhage protocol data were collected. The primary outcome was mean time between massive hemorrhage protocol activation and blood administration during actual trauma resuscitations as analyzed using a two-sample t test. RESULTS: Each group was similar in demographic and injury characteristics. The time from massive hemorrhage protocol activation to blood administration decreased from 11.6 min pre-intervention to 9.1 min post-intervention. This represented a significant reduction (2.5 min, 95% confidence interval, 0.03-5.08) following the in situ simulation-based quality improvement intervention. CONCLUSIONS: A comprehensive, in situ simulation-based quality improvement project was associated with a significant reduction in the mean time between massive hemorrhage protocol activation and blood administration among injured patients. In situ simulation represents a novel approach to the identification and mitigation of latent safety threats during massive hemorrhage protocol activation.
Authors: Nori L. Bradley; Kelsey Innes; Christa Dakin; Andrew Sawka; Nasira Lakha; S. Morad Hameed Journal: Can J Surg Date: 2018-10-01 Impact factor: 2.089
Authors: Christopher J Dente; Beth H Shaz; Jeffery M Nicholas; Robert S Harris; Amy D Wyrzykowski; Snehal Patel; Amit Shah; Gary A Vercruysse; David V Feliciano; Grace S Rozycki; Jeffrey P Salomone; Walter L Ingram Journal: J Trauma Date: 2009-06