El-Shafy Ibrahim Abd, Delgado Jennifer, Akerman Meredith, Bullaro Francesca, Christopherson Nathan A M, Prince Jose M
Department of Surgery, Hofstra Northwell School of Medicine, Cohen Children׳s Medical Center, New Hyde Park, New York; Feinstein Institute for Medical Research, Manhasset, New York; Department of Surgery, Maimonadies Medical Center, Brooklyn, New York.
Department of Surgery, Hofstra Northwell School of Medicine, Cohen Children׳s Medical Center, New Hyde Park, New York.
J Surg Educ. 2018 Jan-Feb;75(1):58-64. doi: 10.1016/j.jsurg.2017.06.025. Epub 2017 Aug 2.
Pediatric trauma care requires effective and clear communication in a time-sensitive manner amongst a variety of disciplines. Programs such as Crew Resource Management in aviation have been developed to systematically prevent errors. Similarly, teamSTEPPS has been promoted in healthcare with a strong focus on communication. We aim to evaluate the ability of closed-loop communication to improve time-to-task completion in pediatric trauma activations.
All pediatric trauma activations from January to September, 2016 at an American College of Surgeons verified level I pediatric trauma center were video recorded and included in the study. Two independent reviewers identified and classified all verbal orders issued by the trauma team leader for order audibility, directed responsibility, check-back, and time-to-task-completion. The impact of pre-notification and level of activation on time-to-task-completion was also evaluated. All analyses were performed using SAS® version 9.4(SAS Institute Inc., Cary, NC).
In total, 89 trauma activation videos were reviewed, with 387 verbal orders identified. Of those, 126(32.6%) were directed, 372(96.1%) audible, and 101(26.1%) closed-loop. On average each order required 3.85 minutes to be completed. There was a significant reduction in time-to-task-completion when closed-loop communication was utilized (p < 0.0001). Orders with closed-loop communication were completed 3.6 times sooner as compared to orders with an open-loop [HR = 3.6 (95% CI: 2.5, 5.3)]. There was not a significant difference in time-to-task-completion with respect to pre-notification by emergency service providers (p < 0.6100). [HR = 1.1 (95% CI: 0.9, 1.3)]. There was also not a significant difference in time-to-task-completion with respect to level of trauma team activation (p < 0.2229). [HR = 1.3 (95% CI: 0.8, 2.1)].
While closed-loop communication prevents medical errors, our study highlights the potential to increase the speed and efficiency with which tasks are completed in the setting of pediatric trauma resuscitation. Trauma drills and systems of communication that emphasize the use of closed-loop communication should be incorporated into the training of trauma team leaders.
This is a prospective observational study with intervention level II evidence.
儿科创伤护理需要多学科之间在时间紧迫的情况下进行有效且清晰的沟通。航空领域的机组资源管理等项目已被开发出来以系统地预防错误。同样，医疗保健领域也在推广团队策略与工具提升绩效系统（TeamSTEPPS），其重点在于沟通。我们旨在评估闭环沟通在儿科创伤救治中提高任务完成时间的能力。
对2016年1月至9月在美国外科医师学会认证的一级儿科创伤中心进行的所有儿科创伤救治进行视频记录并纳入研究。两名独立评审员对创伤团队负责人发出的所有口头医嘱进行识别和分类，评估医嘱的可听性、直接责任、确认回复以及任务完成时间。还评估了预先通知和激活级别对任务完成时间的影响。所有分析均使用SAS® 9.4版（SAS Institute Inc., Cary, NC）进行。
总共审查了89个创伤救治视频，识别出387条口头医嘱。其中，126条（32.6%）有直接责任指示，372条（96.1%）可听清，101条（26.1%）为闭环沟通。平均每条医嘱完成需要3.85分钟。采用闭环沟通时，任务完成时间显著缩短（p < 0.0001）。与开环医嘱相比，闭环沟通的医嘱完成时间快3.6倍[风险比（HR）= 3.6（95%置信区间：2.5, 5.3）]。急救服务提供者的预先通知对任务完成时间没有显著差异（p < 0.6100）。[HR = 1.1（95%置信区间：0.9, 1.3）]。创伤团队激活级别对任务完成时间也没有显著差异（p < 0.2229）。[HR = 1.3（95%置信区间：0.8, 2.1）]。
虽然闭环沟通可预防医疗错误，但我们的研究突出了在儿科创伤复苏中提高任务完成速度和效率的潜力。强调使用闭环沟通的创伤演练和沟通系统应纳入创伤团队负责人的培训中。
这是一项具有二级干预证据的前瞻性观察性研究。
