From the Division of Traumatology, Surgical Critical Care & Emergency Surgery (D.S., K.Q., J.W.C.), Penn Acute Research Collaboration (PARC) (D.S., B.S.A., J.W.C.), Perelman School of Medicine at the University of Pennsylvania; Department of Nursing (P.Z.C., S.H., A.H.), Penn Presbyterian Medical Center, Penn Medicine; University of Pennsylvania School of Nursing Philadelphia (P.Z.C.); Leonard Davis Institute of Health Economics (P.Z.C., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Arcos, Inc. (C.M.), Missouri City, Texas; Department of Emergency Medicine (B.S.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland.
J Trauma Acute Care Surg. 2021 Aug 1;91(2S Suppl 2):S154-S161. doi: 10.1097/TA.0000000000003224.
Damage-control resuscitation (DCR) improves trauma survival; however, consistent adherence to DCR principles through multiple phases of care has proven challenging. Clinical decision support may improve adherence to DCR principles. In this study, we designed and evaluated a DCR decision support system using an iterative development and human factors testing approach.
The phases of analysis included initial needs assessment and prototype design (Phase 0), testing in a multidimensional simulation (Phase 1), and testing during initial clinical use (Phase 2). Phase 1 and Phase 2 included hands-on use of the decision support system in the trauma bay, operating room, and intensive care unit. Participants included trauma surgeons, trauma fellows, anesthesia providers, and trauma bay and intensive care unit nurses who provided both qualitative and quantitative feedback on the initial prototype and all subsequent iterations.
In Phase 0, 14 (87.5%) of 16 participants noted that they would use the decisions support system in a clinical setting. Twenty-four trauma team members then participated in simulated resuscitations with decision support where 178 (78.1%) of 228 of tasks were passed and 27 (11.8%) were passed with difficulty. Twenty-three (95.8%) completed a postsimulation survey. Following iterative improvements in system design, Phase 2 evaluation included 21 trauma team members during multiple real-world trauma resuscitations. Of these, 15 (71.4%) completed a formal postresuscitation survey. Device-level feedback on a Likert scale (range, 0-4) confirmed overall ease of use (median score, 4; interquartile range, 4-4) and indicated the system integrated well into their workflow (median score, 3; interquartile range, 2-4). Final refinements were then completed in preparation for a pilot clinical study using the decision support system.
An iterative development and human factors testing approach resulted in a clinically useable DCR decision support system. Further analysis will determine its applicability in military and civilian trauma care.
Therapeutic/Care Management, Level V.
损伤控制性复苏（DCR）可提高创伤患者的生存率；然而，在多个治疗阶段中始终如一地遵循 DCR 原则一直具有挑战性。临床决策支持系统可能有助于提高对 DCR 原则的依从性。在这项研究中，我们采用迭代开发和人为因素测试方法设计并评估了一种 DCR 决策支持系统。
分析的阶段包括初步需求评估和原型设计（阶段 0）、多维模拟测试（阶段 1）以及初步临床应用测试（阶段 2）。阶段 1 和阶段 2 包括在创伤病房、手术室和重症监护病房中实际使用决策支持系统。参与者包括创伤外科医生、创伤研究员、麻醉师以及创伤病房和重症监护病房护士，他们对初始原型和所有后续迭代提供了定性和定量反馈。
在阶段 0 中，16 名参与者中的 14 名（87.5%）表示他们将在临床环境中使用该决策支持系统。随后，24 名创伤团队成员参与了带有决策支持的模拟复苏，其中 228 项任务中有 178 项（78.1%）通过，27 项（11.8%）通过有一定难度。23 名（95.8%）参与者完成了模拟后调查。在系统设计的迭代改进之后，在多个真实创伤复苏中，有 21 名创伤团队成员参与了阶段 2 评估。其中，15 名（71.4%）完成了正式的复苏后调查。使用李克特量表（范围，0-4）对设备级别反馈进行的评估证实了总体易用性（中位数评分，4；四分位距，4-4），并表明该系统很好地融入了他们的工作流程（中位数评分，3；四分位距，2-4）。随后完成了最终的改进，为使用决策支持系统进行试点临床研究做准备。
采用迭代开发和人为因素测试方法开发了一种临床可用的 DCR 决策支持系统。进一步的分析将确定其在军事和民用创伤护理中的适用性。
治疗/护理管理，等级 V。
