Toth Eric W, Richardson Kristopher, Berry Courtney, Butki Nikolai
Clinical Instructor/Emergency Medicine Resident, McLaren Oakland, Pontiac, MI.
Core Faculty, Emergency Medicine Residency Program, McLaren Oakland, Pontiac, MI.
Spartan Med Res J. 2017 Feb 2;1(2):5126. doi: 10.51894/001c.5126.
Trauma patients frequently represent a unique and challenging patient population in emergency medicine care settings. The policy of the McLaren Oakland Emergency Department (ED) is to have the treatment of all Level 1 and Level 2 trauma activations dictated by the ED resident. This policy is intended to facilitate both patient safety through clear communication between multiple medical services and quality improvement through reporting trauma specific quality metrics to third party agencies. Despite this requirement, trauma dictations in this setting were often found to not be completed. The purpose of this quality improvement/patient safety project was to implement a trauma dictation template to increase the rate of completed ED trauma dictations to above 75% of all Level 1 and Level 2 trauma activations.
A trauma dictation template was created to aid ED residents while completing trauma dictations. It was thought by the authors that the implementation of a standardized dictation template would help residents specify the necessary components needed to improve both patient safety and quality reporting. The development of the template was a collaborative effort between the emergency medicine residents and faculty, the trauma coordinator and trauma surgeons. The project was evaluated using two separate measures. A "process measure" was first used to determine if the addition of the trauma template made dictating less burdensome for ED residents, and an "outcomes measure" helped the authors examine whether template implementation actually led to an increased rate in completed trauma dictation.
Data were collected during a three-month period prior to template implementation and three months after implementation. From November, 2015 through April, 2016, a total of 132 Trauma Activations were reviewed. The rate of completed dictations on Level 1 trauma activations increased from 45.16% to 53.33%. However, the rate of dictations on Level 2 trauma activations decreased from 50% to 30.4%, suggesting that Level 1 trauma patient care may have derived greater improvements from the new dictation template.
The results of the ED residents' evaluative survey responses were generally positive, indicating that the trauma template was perceived by most residents as a useful tool to complete dictations. Even though the outcome goal was not achieved, the project successfully achieved the goal of creating and implementing a usable trauma dictation template. Following the Plan-Do-Study-Act model for quality improvement/patient safety projects, the next project will examine additional barriers preventing users from utilizing this initial well-received tool.
在急诊医疗环境中，创伤患者常常是一类独特且具有挑战性的患者群体。迈凯轮奥克兰急诊科（ED）的政策是，所有1级和2级创伤激活病例的治疗均由急诊科住院医师决定。该政策旨在通过多个医疗服务部门之间的清晰沟通促进患者安全，并通过向第三方机构报告创伤特定质量指标来推动质量改进。尽管有此要求，但在这种情况下，创伤记录往往未完成。这个质量改进/患者安全项目的目的是实施一个创伤记录模板，将急诊科创伤记录的完成率提高到所有1级和2级创伤激活病例的75%以上。
创建了一个创伤记录模板，以帮助急诊科住院医师完成创伤记录。作者认为，实施标准化记录模板将有助于住院医师明确提高患者安全和质量报告所需的必要组成部分。该模板的开发是急诊科住院医师与教员、创伤协调员和创伤外科医生共同努力的结果。该项目使用两种单独的衡量标准进行评估。首先使用“过程衡量标准”来确定添加创伤模板是否使急诊科住院医师的记录负担减轻，“结果衡量标准”则帮助作者检查模板的实施是否实际上导致完成的创伤记录率提高。
在模板实施前的三个月和实施后的三个月期间收集数据。从2015年11月到2016年4月，共审查了132例创伤激活病例。1级创伤激活病例的记录完成率从45.16%提高到53.33%。然而，2级创伤激活病例的记录率从50%下降到30.4%，这表明1级创伤患者的护理可能从新的记录模板中获得了更大的改善。
急诊科住院医师评估调查的结果总体上是积极的，表明大多数住院医师认为创伤模板是完成记录的有用工具。尽管没有实现结果目标，但该项目成功实现了创建和实施可用的创伤记录模板的目标。遵循质量改进/患者安全项目的计划-执行-研究-行动模型，下一个项目将研究阻碍用户使用这个最初广受好评的工具的其他障碍。
