Failure Mode Effects Analysis of Re-triage of Injured Patients to Receiving High-Level Illinois Trauma Centers.

IF 7.5 1区 医学 Q1 SURGERY
John D Slocum, Jane L Holl, William M Brigode, Mary Beth Voights, Michael J Anstadt, Marion C Henry, Justin Mis, Richard J Fantus, Timothy P Plackett, Eddie J Markul, Grace H Chang, Michael B Shapiro, Nicole Siparsky, Anne M Stey
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引用次数: 0

Abstract

Objective: This study identified failures in emergency inter-hospital transfer, or re-triage, at high-level trauma centers receiving severely injured patients.

Summary background data: The re-triage process averages four hours despite the fact timely re-triage within two hours mitigates injury-associated mortality. Non-trauma and low-level trauma centers reported most critical failures were in finding an accepting high-level trauma center. Critical failures at high-level trauma centers have not been assessed.

Methods: This was an observational cross-sectional study at nine high-level adult trauma centers and three high-level pediatric trauma centers. Failure Modes Effects Analysis (FMEA) of the re-triage process was conducted in four phases. Phase 1 purposively sampled trauma coordinators followed by snowball sampling of clinicians, operations, and leadership to ensure representative participation. Phase 2 mapped each re-triage step. Phase 3 identified failures at each step. Phase 4 scored each failure on impact, frequency, and safeguards for detection. Standardized rubrics were used in Phase 4 to rate each failure's impact (I), frequency (F), and safeguard for detection (S) to calculate their Risk Priority Number (RPN) (I x F x S). Failures were rank ordered for criticality.

Results: A total of 64 trauma coordinators, surgeons, emergency medicine physicians, nurses, operations and quality managers across twelve high-level trauma centers participated. There were 178failures identified at adult and pediatric high-level trauma centers. The most critical failures were: Insufficient trained transport staff (RPN=648); Issues transmitting imaging from sending to receiving centers (RPN=400); Incomplete exchange of clinical information(RPN=384).

Conclusions: The most critical failures were limited transportation and incomplete exchange of clinical, radiological and arrival timing information. Further investigation of these failures that includes several regions is needed to determine the reproducibility of these findings.

将受伤病人重新分流到伊利诺伊州高级创伤中心的故障模式效应分析。
目的:本研究确定了接收重伤患者的高级创伤中心在医院间紧急转运或再分流方面的失败:本研究发现了接收重伤患者的高级创伤中心在医院间紧急转运或重新分流方面的失误:尽管在两小时内及时重新转运可降低与受伤相关的死亡率,但重新转运过程平均需要四小时。非创伤中心和低级别创伤中心报告称,最严重的失败是找不到可接受的高级别创伤中心。尚未对高级别创伤中心的重大失误进行评估:这是一项观察性横断面研究,研究对象是九个高级别成人创伤中心和三个高级别儿童创伤中心。重新分流流程的故障模式影响分析(FMEA)分四个阶段进行。第一阶段有目的性地对创伤协调员进行抽样,然后对临床医生、操作人员和领导层进行滚雪球式抽样,以确保参与的代表性。第 2 阶段绘制每个再分流步骤图。第 3 阶段确定每个步骤的失败之处。第 4 阶段对每个故障的影响、频率和检测保障措施进行评分。第 4 阶段使用标准化评分标准对每个故障的影响 (I)、频率 (F) 和检测保障 (S) 进行评分,以计算其风险优先级编号 (RPN)(I x F x S)。故障的严重程度按等级排序:共有 12 个高级创伤中心的 64 名创伤协调员、外科医生、急诊内科医生、护士、运营和质量管理人员参与了此次研究。成人和儿童高级创伤中心共发现 178 个故障。最严重的故障包括训练有素的转运人员不足(RPN=648);从发送中心到接收中心的影像传输问题(RPN=400);临床信息交换不完整(RPN=384):最关键的故障是运输受限以及临床、放射和到达时间信息交流不完整。需要在多个地区对这些故障进行进一步调查,以确定这些结果的可重复性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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