A Qualitative Study Exploring the Regional Feasibility of Patient-Reported Outcome Measures (PROMs) Data Collection for Orthopedic Trauma Patients.

INTRODUCTION: Behavioral health has been shown to impact both short- and long-term health outcomes in trauma patients. Recommendations for screening for behavioral health concerns in the acute setting exist, but longitudinal data collection is infrequently performed. The Trauma Quality Improvement Program describes the importance of patient-reported outcome measures (PROMs), including behavioral health data. METHODS: In this qualitative feasibility study, a multidisciplinary team participated in one-hour virtual focus groups; a semi-structured interview guide was used to ascertain feedback on a proposed PROMs study design. This study utilized a qualitative methodology to reveal thematic results from the staff feedback to determine the feasibility of the proposed study design. RESULTS: Three virtual one-hour focus groups consisting of a combination of seven trauma program managers and orthopedic practice managers were asked questions related to the feasibility of a PROMs study design before thematic saturation was reached. Through the analysis, four themes emerged: barriers, possible improvements, representation and research design. Themes included subthemes as well. Noteworthy results included the impact of an integrated orthopedic practice and the technological options available for use. CONCLUSION: This study revealed the barriers that would exist in the implementation of PROMs for orthopedic trauma patients, which may be useful when designing data collection procedures for PROMs. The results related to barriers may assist other trauma centers or regional trauma systems in designing an optimal methodology for PROMs data. Furthermore, the American College of Surgeons might consider these results prior to any mandated implementation of PROMs for trauma centers to avoid any possible burden on staff and systems.

Evolution of a mass casualty drill design team: A program evaluation.

INTRODUCTION: The number of mass casualty incidents (MCIs) is increasing. While many healthcare systems have not experienced an MCI, the need for preparedness is ever present. The unique challenges of MCI preparedness require the use of simulation, which has been found to be an effective model for training in medical environments. OBJECTIVE: To determine common discussion points when a multidisciplinary team designed and implemented in situ MCI simulation drills to enhance our emergency preparedness plan. DESIGN: This was a retrospective qualitative evaluation of the multidisciplinary mass casualty drill design team's weekly meeting minutes documents. These documents provided insight into the evolution of a mass casualty drill design team and the advancement of our emergency response plan. RESULTS: Continuous discussions surrounding resource restraints helped to inform the emergence of the three themes, which were "Staff," "Space," and "Stuff." These three themes were further broken down into different subthemes, but there was a continued focus on resource scarcity. CONCLUSIONS: Our results indicate the use of an MCI drill design team and in situ simulations assisted in better understanding of how hospital departments struggled with resource scarcity and provided opportunities to strengthen the emergency preparedness response plan. Incorporating a multidisciplinary mass casualty drill design team helped to ensure different perspectives and department needs were acknowledged and addressed through the in situ simulation trainings.

Staff Perspectives of Mass Casualty Incident Preparedness.

Introduction Mass casualty incidents (MCI) are low-frequency, high-risk events that disrupt the day-to-day operations of medical centers. Day-to-day protocols are insufficient for effectively managing MCI events, creating a need to develop and test MCI-specific protocols. The aim of this project was to utilize interviews to gain insight into staff experience and perspective on MCIs and their institution's response plans. Methods Staff members who participated in an MCI drill were asked semi-structured interview questions regarding their perspectives on their current priorities, the information needed to perform their role, and their greatest concerns about an MCI. This quality improvement (QI) project utilized a qualitative methodology to thematically organize the results of the staff responses. Results A total of 64 staff members with various levels of patient care experience were interviewed to reach thematic saturation. The use of staff interviews helped to identify the four primary themes that emerged, which were: 1) process, 2) supplies and resources, 3) communication, and 4) roles. Furthermore, each theme also included a number of subthemes. Conclusions This project demonstrated the importance of staff experiences related to MCI simulation training and preparedness, which may be useful for future training and emergency response planning. Additionally, the results may be helpful for other institutions when building a robust MCI simulation training program or designing an emergency response plan.

A Critical Pathway for Mass Casualty Incident Preparedness.

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Pediatric all-terrain vehicle trauma: the epidemic continues unabated.

OBJECTIVES: The popularity of all-terrain vehicles (ATVs) continues to increase, but this form of recreation is not as well regulated and can impact children disproportionately. This study examines the epidemiology of ATV injuries in Arizona with emphasis on pediatric injuries and compares ATV injuries to those associated with motorcycle (MCC) and motor vehicle crashes (MVC). METHODS: The trauma registry of a level 1 trauma center was used to identify all ATV crashes during a 5-year period (2004-2008) in patients younger than 16 years. Registration data of ATV were obtained from the state DMV. All-terrain vehicle-related injuries were compared with both MVC and MCC. RESULTS: A total of 250 pediatric ATV crashes were observed during the 5-year period, rising from 29 in 2004 to 53 in 2008. The median age of patients with ATV-related injuries was 13 years, which is higher than that of patients with MVC-related injuries (9 years). Only 34% of the patients with ATV-related injuries were helmeted, compared with 55% of patients with MCC-related injuries. All-terrain vehicle-related crashes were at least 30 times more likely than MVCs and almost 20 times more likely than MCCs. Statewide pediatric ATV deaths rose during the study period. CONCLUSIONS: All-terrain vehicle-related crashes have increased during this study period and have become a significant source of injuries. Public education and awareness of the dangers associated with ATV use need to be targeted toward both parents and children likely to use ATVs.