Department of Research, Sponsored Programs, and Innovation, Summa Health, Akron, Ohio (Dr Moran); Division of Trauma, Department of Surgery, Summa Health System-Akron Campus, Akron, Ohio (Drs Moran, Blecker, and George); Northeast Ohio Medical University, Rootstown, Ohio (Drs Blecker and George); and BIOSTATS Inc, Data Analysis for Clinical Research Studies, East Canton, Ohio (Mr Gothard).
J Trauma Nurs. 2021;28(4):275-280. doi: 10.1097/JTN.0000000000000597.
Rates of mass casualty incidents (MCIs) have been on the rise in the United States, highlighting the need for health care systems to have an emergency response plan. Trauma centers are fundamental during MCIs and serve a crucial leadership role in preparedness for them.
The purpose of this study was to describe the design and implementation of simulated MCI drills at an American College of Surgeons verified Level I trauma center in the Midwest.
A quasi-experimental time-series design was utilized to determine MCI simulation effects on staff performance using an emergency department checklist to measure emergency department throughput time. A multidisciplinary MCI design team developed a checklist for the emergency department, which identified tasks required to complete it. The 16-item checklist, Critical Pathway Management methodology, was used to identify the critical pathway for patient throughput during a surge. Two in situ MCI simulation drills were conducted in the emergency department (October and December 2019), and Critical Pathway Management identified the primary patient throughput rate limiters as notification and inpatient nursing staff presentation.
Emergency department throughput decreased from a mean of 15 to 11 min (reduction of 26.7%) between the two time periods after focusing on rate-limiting tasks.
This quality improvement project demonstrated that the use of institution-specific checklists and Critical Pathway Management to identify critical pathways and potential rate limiters led to patient throughput improvements.
美国大规模伤亡事件（MCIs）的发生率一直在上升，这凸显了医疗保健系统需要制定应急响应计划。创伤中心在 MCIs 中至关重要，并在为此类事件的准备工作中发挥着关键的领导作用。
本研究旨在描述在美国中西部一家获得美国外科医师学会认证的一级创伤中心进行模拟 MCI 演练的设计和实施。
采用准实验时间序列设计，使用急诊科检查表来衡量急诊科通过时间，以确定 MCI 模拟对员工绩效的影响。一个多学科的 MCI 设计团队为急诊科制定了一份检查表，确定了完成任务所需的任务。该 16 项检查表，即关键路径管理方法，用于确定在激增期间患者通过的关键路径。在急诊科进行了两次现场 MCI 模拟演练（2019 年 10 月和 12 月），关键路径管理确定了通知和住院护理人员的呈现是主要的患者通过率限制因素。
在关注限速任务后，两个时间段之间急诊科的通过时间从平均 15 分钟减少到 11 分钟（减少了 26.7%）。
这个质量改进项目表明，使用特定于机构的检查表和关键路径管理来识别关键路径和潜在的限速因素，可以提高患者的通过速度。
