Kuhlenschmidt Kali M, Choi Elias, Moonmoon Kazi, Blackwell James, Comish Paul B, Balentine Courtney, Grant Jennifer, Park Caroline, Dultz Linda A, Shoultz Thomas, Cripps Michael W, Dumas Ryan P
Department of Surgery, University of Texas Southwestern, Dallas, Texas.
Texas Christian University, Fort Worth, Texas.
J Surg Res. 2022 Jun;274:207-212. doi: 10.1016/j.jss.2021.12.048. Epub 2022 Feb 18.
Delays in transition to the next phase of care result in increased mortality. Prehospital literature suggests emergency medical service technicians underestimate transport times by as much as 20%. What remains unknown is clinician perception of time during the trauma resuscitation. We sought to determine if clinicians have an altered perception of time. We hypothesized that clinicians underestimate time, resulting in delay of care.
Clinicians at a large level 1 trauma center completed a post-trauma activation survey on the perceived elapsed time to complete three specific resuscitation endpoints. The primary study endpoint was the time to the next phase of care, defined as leaving the trauma bay to go to the operating room, interventional radiology, computerized tomography or time of death. The data from the surveys were linked and compared with recorded videos of the resuscitations. The difference in perceived versus actual time, along with confounding variables, was used to assess the impact of perception of time on the time to the next phase of care using a stepwise multivariate linear model.
There were 284 complete surveys and videos, culminating in 543 time points. The median perceived versus actual time (minutes [interquartile range]) to the next phase of care was 20 [10-25] versus 26 [19-40] (P < 0.001). Overall, clinicians underestimated time by 28%, such that if the resuscitation lasted 20 min, the clinician's perception was that 14.4 min elapsed. Differences in the perceived versus actual time in the procedure group impacted time to the next phase of care (P = 0.01).
Clinicians have significant gaps in the perception of time during trauma resuscitations. This misperception occurs during procedures and correlates with an increase in the length of time to the next phase of care.
向护理下一阶段过渡的延迟会导致死亡率上升。院前急救文献表明，紧急医疗服务技术人员对转运时间的低估高达20%。目前尚不清楚临床医生在创伤复苏过程中对时间的感知情况。我们试图确定临床医生是否对时间有不同的感知。我们假设临床医生低估了时间，从而导致护理延迟。
一家大型一级创伤中心的临床医生完成了一项创伤后激活调查，内容是关于完成三个特定复苏终点的感知 elapsed 时间。主要研究终点是进入护理下一阶段的时间，定义为离开创伤病房前往手术室、介入放射科、计算机断层扫描室或死亡时间。将调查数据与复苏过程的记录视频进行关联和比较。使用逐步多元线性模型，将感知时间与实际时间的差异以及混杂变量用于评估时间感知对进入护理下一阶段时间的影响。
共有284份完整的调查和视频，最终得到543个时间点。进入护理下一阶段的感知时间与实际时间的中位数（分钟[四分位间距]）分别为20[10 - 25]和26[19 - 40]（P < 0.001）。总体而言，临床医生低估时间28%，即如果复苏持续20分钟，临床医生的感知是过去了14.4分钟。手术组中感知时间与实际时间的差异影响了进入护理下一阶段的时间（P = 0.01）。
临床医生在创伤复苏过程中的时间感知存在显著差距。这种错误感知发生在手术过程中，并与进入护理下一阶段的时间延长相关。
