Contemporary uses of trauma video review: a scoping review.

OBJECTIVES: Trauma resuscitations are sporadic, high-acuity situations and conducting observation in the trauma bay for the purpose of quality improvement is challenging. We aim to review contemporary uses of trauma video review. METHODS: Medline and Embase were searched from 1980 to May 2020 for studies involving trauma video review. English studies of adult and paediatric populations were included for study and analysed for uses of trauma video review, outcomes measured and any resulting quality improvement (QI) initiatives. RESULTS: A total of 463 publications were identified with 21 studies meeting eligibility for final inclusion. A majority of studies (11) observed technical skills with analysis of critical procedures, including tracheal intubation and thoracotomy. The remaining studies observed team dynamics and communication. Overall, eight studies resulted in new policies being put in place for trauma resuscitations and six studies utilized trauma video review as an educational tool. CONCLUSIONS: This study highlights common uses of trauma video review. The greatest benefit for this new technology is in quality improvement and education. The majority of studies focussed on critical procedures and QI initiatives, such as checklists, protocols and continued education. We recommend adoption of video review systems for ongoing improvement of team dynamics and overall trauma and emergency resuscitation.

RéSUMé: OBJECTIFS: Les réanimations traumatiques sont des situations sporadiques à haute acuité et il est difficile de mener des observations dans la salle de traumatologie dans le but d'améliorer la qualité. Notre objectif est de passer en revue les utilisations contemporaines de l'examen vidéo des traumatismes. MéTHODES: Des recherches ont été menées dans Medline et Embase de 1980 à mai 2020 pour trouver des études impliquant un examen vidéo de traumatismes. Les études anglaises portant sur des populations adultes et pédiatriques ont été incluses dans l'étude et analysées en fonction des utilisations de l'examen vidéo des traumatismes, des résultats mesurés et de toute initiative d'amélioration de la qualité (AQ) en résultant. RéSULTATS: Un total de 463 publications a été identifié avec 21 études répondant aux critères d'éligibilité pour l'inclusion finale. Une majorité d'études (11) ont observé les compétences techniques avec l'analyse des procédures critiques, notamment l'intubation trachéale et la thoracotomie. Les autres études ont observé la dynamique de l'équipe et la communication. Dans l'ensemble, 8 études ont donné lieu à la mise en place de nouvelles politiques pour les réanimations traumatiques et 6 études ont utilisé l'examen de vidéos de traumatismes comme outil éducatif. CONCLUSIONS: Cette étude met en évidence les utilisations courantes de l'examen vidéo des traumatismes. Le plus grand avantage de cette nouvelle technologie est l'amélioration de la qualité et l'éducation. La majorité des études se sont concentrées sur les procédures critiques et les initiatives d'AQ, telles que les listes de contrôle, les protocoles et la formation continue. Nous recommandons l'adoption de systèmes de révision vidéo pour l'amélioration continue de la dynamique d'équipe et de la réanimation de traumatologie et d'urgence en général.

Errors in adult trauma resuscitation: a systematic review.

INTRODUCTION: Trauma resuscitation at dedicated trauma centers typically consist of ad-hoc teams performing critical tasks in a time-limited manner. This creates a high stakes environment apt or avoidable errors. Reporting of errors in trauma resuscitation is generally center-dependent and lacks common terminology. METHODS: We conducted a systematic review by searching Ovid Medline, Scopus and Embase from inception to February 24, 2021 for errors in adult trauma resuscitation. English studies published after 2001 were included. Studies were assessed by two independent reviewers for meeting inclusion/exclusion criteria. Errors were characterized from the included studies and a summary table was developed. Our review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020152875). RESULTS: The literature search retrieved 4658 articles with 26 meeting eligibility criteria. Errors were identified by morbidity and mortality rounds or other committee in 62%, missed injuries on tertiary assessment or radiology review in 12%, deviations from algorithmic guidelines in 12% or predefined for chest tube complications, critical incident reporting, aspiration or delays in care. In total there were 39 unique error types identified and divided into 9 categories including Emergency Medical Services handover, airway, assessment of injuries, patient monitoring and access, transfusion/blood related, management of injuries, team communication/dynamics, procedure error and disposition. CONCLUSIONS: Overall, our systematic review identified 39 unique error types in trauma resuscitation. Identifying these errors is imperative in developing systems for improvement of trauma care.

Factors associated with non-optimal resource utilization of air ambulance for interfacility transfer of injured patients.

OBJECTIVE: Timely access to definitive care is associated with improved outcomes in trauma patients. The goal of this study is to identify patient, institutional and paramedic risk factors for non-optimal resource utilization for interfacility transfers of injured adult patients transported by air ambulance to a LTC. METHODS: This is a retrospective cohort study of adult emergent interfacility transports via Ornge with data collected on patient demographics, clinical status, sending facilities, transport details and paramedic qualifications. A logistic regression model was used to analyze data. RESULTS: 1777 injured patients undergoing transport with Ornge were analyzed with 805 of these undergoing non-optimal transport. Patients who had an optimal resource use were found to be older and mechanically ventilated. Risk factors increasing odds of non-optimal transport included patients transported from a nursing station (OR 1.94), transport with primary or advanced care paramedics (OR 6.57 and 1.44, respectively) and transport between both 0800-1700 and 1700-0000 (OR 1.40 and 1.54, respectively). The median delay to arrival to receiving facility if a patient had a non-optimal resource use was 40 minutes. CONCLUSIONS: Three main risk factors were identified in this study. We believe that nursing stations as a sending facility and type of paramedics crew transporting patients resulted in non-optimal resource utilization primarily due to triage of lower acuity patients. However the timing of day is more likely to be a resource availability issue and something that can be further studied and potentially improved moving forward.