Trauma Care Breakthrough: Enhancing Performance Improvement through Trauma Video Review

Every second counts in the resuscitation bay, and actions and decisions can mean the difference between life and death. As medical professionals, we constantly strive to advance our skills and streamline our processes, with the ultimate goal of improving our patient outcomes. One of the most powerful tools in this pursuit of excellence is continuous improvement¹ through rigorous self-assessment and team performance evaluation.  

Traditional methods of quality improvement in trauma resuscitation involve the analysis of the electronic medical record (EMR) to identify opportunities to improve processes of care. However, there are several challenges in analyzing trauma resuscitation performance² that make it difficult to reconstruct the sequence of events when analyzing care and identifying potential adverse events, including: 

• Up to half of the activities that occur in the trauma bay are not captured as part of the EMR³ 

• Care happens very quickly and simultaneously   

• Multiple clinicians may be delivering care concurrently  

• The fast-paced nature of trauma makes documentation particularly challenging

Enter the Trauma Black Box® for high-definition audiovisual trauma video review in resuscitation bays. This groundbreaking approach is a revolution in how we analyze, learn from, and think about trauma performance improvement.  

The Role of Video Review in Trauma Care 

Trauma Video Review is quickly being recognized as a valuable tool throughout trauma centers in the United States. It allows teams to access high-definition audiovisual recordings of trauma resuscitations to: 

• Analyze both individual and team performance objectively 

• Target specific areas for improvement⁴ 

• Recognize, reinforce, and teach best practices Enhance communication and teamwork 

• Evaluate technical performance and benchmarks

High-definition video with multiple camera angles and clear audio recordings specifically designed for medical review represent a tremendous leap in trauma performance improvement. They enable teams to study their processes and systems⁵ when treating patients within the golden hour of trauma care such as: 

• Pre-arrival timeouts, EMS timeouts, and team pre- and de-briefs  

• Time to perform critical procedures such as vascular access and intubation 

• Team dynamics, communication, and leadership 

• Hand-offs during processes of care  

Organizations may choose to incorporate Trauma Video Review into several of their existing quality improvement efforts. These videos provide new depth to peer review conferences, root cause analyses, weekly multidisciplinary conferences or grand rounds, and other similar ongoing efforts. Regularly, structured review sessions provide insights to inform protocol updates, best practices, and training programs. Ultimately teams are empowered to engage in more productive, evidence-based discussions about their performance.⁶  

Addressing Potential Concerns About Trauma Video Review 

Privacy and security are often at the forefront of concerns for patients, clinicians, and hospital administration. Strict and customizable protocols can be set around accessing and reviewing video recordings within an organization. Legal considerations are another hurdle, but when properly implemented, can provide protection by documenting adherence to best practices.⁷  

Cost and implementation challenges may be a barrier for some institutions, though the long-term benefits in improved care and potential reduction in adverse events often outweigh the initial investment. Some organizations have found success in pursuing grant funding for the initial implementation, and/or ongoing research.  

Creating a supportive patient safety culture is crucial for the successful implementation⁸ of video review in trauma performance improvement. Culture should emphasize a non-punitive environment where the focus is on learning and improvement rather than blame. Teams fostering this approach can leverage video review for powerful pattern recognition, identifying both exemplary practices and areas for optimization. Video review is particularly valuable for training on high-impact, low-frequency procedures, allowing teams to prepare for rare but critical scenarios.   

Furthermore, the automated deletion of videos after a preset expiration date and the ability to de-identify videos selected for longer-term storage, if desired by the organization, can help alleviate privacy concerns while still maintaining the educational value of the footage. This feature can make team members more comfortable with the review process, encouraging open and honest discussions about performance.   Ultimately, a well-implemented video review system, backed by a strong patient safety culture, can lead to significant improvements in trauma care outcomes and team dynamics.  

Data-Driven Performance Improvement 

The integration of Trauma Video Review in trauma resuscitation bays represents a significant leap forward in our ability to provide the highest quality care to trauma patients. We can continuously refine skills, improve processes, and ultimately save more lives by providing objective, detailed insights into our performance.⁹ The question is no longer whether to implement video review, but how quickly it can be done. The time to revolutionize trauma performance improvement is now – and audiovisual review is the key to unlocking the full potential. 

Recommended Reading 

1. World Health Organization Department of Violence and Injury Prevention and Disability. (2009). Guidelines for Trauma Quality Improvement Programmes. https://www.who.int/publications/i/item/guidelines-for-trauma-quality-improvement-programmes.  

2. Nazir, A., Shore, E. M., Stoneman, C. K., et. al. (2024). Enhancing patient safety in trauma: Understanding adverse events, assessment tools, and the role of trauma video review. Am J Surg, 234; 74-79. https://www.sciencedirect.com/science/article/pii/S0002961024002642.  

3. Kieffer, J. C., Thompson, A., Elwell, S. & DePiero, A. (2021). Comparison of paper and electronic documentation of trauma activations in a pediatric trauma center. Am J Emerg Med, 50; 719-723. https://pubmed.ncbi.nlm.nih.gov/34879492/.  

4. Nazir, A., Baletic, N., Dumas, R. P., et al. (2024). Reliability of the safety threats and adverse events in Trauma (STAT) taxonomy using trauma video review. Eur J Trauma Emerg Surg, 50(2), 497-504. https://pubmed.ncbi.nlm.nih.gov/37979061/   

5. Nagaraj, M. B., Lowe, J. E., Marinica, A. L., et al. (2023). Using Trauma Video Review to Assess EMS Handoff and Trauma Team Non-Technical Skills. Prehosp Emerg Care, 27(1), 10-17. https://pubmed.ncbi.nlm.nih.gov/34731071/.  

6. Nolan, B., Hicks, C. M., Petrosoniak, A., et al. (2020). Pushing boundaries of video review in trauma: using comprehensive data to improve the safety of trauma care. Trauma Surg Acute Care Open, 12:5. https://pubmed.ncbi.nlm.nih.gov/32685694/.  

7. Dumas, R. P., Cook, C., Holena, D. N., et. al. (2022). Roll the Tape: Implementing and Harnessing the Power of Trauma Video Review. J Surg Educ, 76(6), 248-256.  

8. Dainty, K. N., Seaton, M. B., McGowan, M., & Nolan, B. (2021). Staff perceptions of the implementation of a trauma video review program at a level 1 trauma center. AEM Educ Train, 5(4), e10714. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8675834/.  

9. Maiga, A. M., Vella, M. A., Appelbaum, R. D., et al. (2024). Getting out of the bay faster: Assessing trauma team performance using trauma video review. J Trauma Acute Care Surg, 96(1), 76-84. https://pubmed.ncbi.nlm.nih.gov/37880840/.