TRAUMA QUALITY IMPROVEMENT

Benchmarking emergency department thoracotomy

Using trauma video review to generate procedural norms

Using trauma video review to generate procedural norms

Using trauma video review to generate procedural norms

Published on

May 23, 2018

Injury

Ryan P Dumas, Kristen M Chreiman, Mark J Seamon, Jeremy W Cannon, Patrick M Reilly, Jason D Christie, Daniel N Holena
Ryan P Dumas, Kristen M Chreiman, Mark J Seamon, Jeremy W Cannon, Patrick M Reilly, Jason D Christie, Daniel N Holena
Ryan P Dumas, Kristen M Chreiman, Mark J Seamon, Jeremy W Cannon, Patrick M Reilly, Jason D Christie, Daniel N Holena

Overview

This study aimed to establish procedural benchmarks for emergency department thoracotomy (EDT) by utilizing trauma video review (TVR) to define normative times for key milestones. A total of 44 EDTs were analyzed, focusing on four specific milestones: right chest decompression, retractor deployment, pericardiotomy, and aortic cross-clamp. The results indicated that median times for these milestones varied, with notable delays for many procedures. Approximately 64% of the EDTs were categorized as outliers due to exceeding the 75th percentile for milestone times or omitting milestones altogether. Additionally, TVR data demonstrated significantly lower rates of missing information compared to traditional electronic medical record (EMR) data, highlighting its potential for enhancing data quality in procedural reviews.

The findings suggest that video analysis can effectively delineate normative procedural times for EDTs and identify areas for quality improvement. Given the prevalence of technical outliers, further research is warranted to explore the relationship between procedural efficiency and patient outcomes, potentially guiding future training and resuscitation practices in emergency settings.

Results

44 EDTs were included from the study period. Patients had a median age of 30 [IQR 25-44] and were predominantly African-American (95%) males (93%) with penetrating trauma (95%). From skin incision, median times in minutes to milestones were as follows: right chest decompression: 2.11 [IQR 0.68-2.83], retractor deployment 1.35 [IQR 0.96-1.85], pericardiotomy 2.35 [IQR 1.85-3.75], aortic cross-clamp 3.71 [IQR 2.83-5.77]. In total, 28/44 (64%) of EDTs were either high outliers for one or more benchmarks or had milestones that were omitted. For all milestones, rates of missingness for TVR data were lower than EMR data (p < 0.001).