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Randall S Burd - One of the best experts on this subject based on the ideXlab platform.
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Multidisciplinary Simulation-Based Team Training for Trauma Resuscitation: A Scoping Review.
Journal of surgical education, 2019Co-Authors: Cory Mclaughlin, Randall S Burd, Wesley E. Barry, Erica N. Barin, Lynn Kysh, Marc Auerbach, Jeffrey S. Upperman, Aaron R. JensenAbstract:Objective Simulation-based training as an educational intervention for healthcare providers has increased in use over the past 2 decades. The simulation community has called for standardized reporting of methodologies and outcomes. The purpose of this review was to (1) summarize existing data on the use of simulation-based team training for acute Trauma Resuscitation, and (2) describe differences in training methodologies, outcomes reporting, and gaps in the literature to inform research priorities. Design We performed a scoping review of Ovid Medline, Embase, Cochrane Library, CINAHL, Web of Science, ERIC, and Google Scholar for studies evaluating simulation-based team training for acute Trauma Resuscitation. Full-text review was performed by 2 reviewers and variables related to study design, training methodology, outcomes reported, and impact of training were abstracted. Results Forty-seven out of 3,911 screened studies met criteria for inclusion. Only 2 studies were randomized. The most frequent design was a pre-post study (64%). Eleven studies did not report their simulated scenario design. Interventions occurred most frequently in a laboratory-based setting (45%). Simulation-based training was associated with greater knowledge (n = 5/6), higher nontechnical skills (n = 12/13), greater number of Resuscitation tasks completed (n = 10/13), and faster time to Resuscitation task completion (n = 11/11). No differences in patient outcomes were found (n = 3/3). Conclusions Simulation-based training for Trauma Resuscitation is associated with improved measures of teamwork, task performance and speed, knowledge, and provider satisfaction. Type of reported outcomes and training methodologies are variable. Standardized reporting of training methodology and outcomes is needed to address the impact of this intervention.
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ICHI - Intention Mining in Medical Process: A Case Study in Trauma Resuscitation
IEEE International Conference on Healthcare Informatics. IEEE International Conference on Healthcare Informatics, 2018Co-Authors: Sen Yang, Aleksandra Sarcevic, Shuhong Chen, Ivan Marsic, Richard A. Farneth, Xin Dong, Randall S BurdAbstract:In medical processes such as surgical procedures and Trauma Resuscitations, medical teams perform treatment activities according to underlying invisible goals or intentions. In this study, we presented an approach to uncover these intentions from observed treatment activities. Developed on top of a hierarchical hidden Markov model (H-HMM), our approach can identify multi-level intentions. To accurately infer the H-HMM, we used state splitting method with maximum a posteriori probability (MAP) as the scoring function. We evaluated our approach in both qualitative and quantitative ways, using a case study of the Trauma Resuscitation process. This dataset includes 123 Trauma Resuscitation cases collected at a level 1 Trauma center. Our results show our intention mining achieved an accuracy of 86.6% in classifying medical teams' intentions. This work shows the feasibility of unsupervised intention mining of complex real-world medical processes.
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ICHI - Process Mining the Trauma Resuscitation Patient Cohorts
IEEE International Conference on Healthcare Informatics. IEEE International Conference on Healthcare Informatics, 2018Co-Authors: Sen Yang, Shuhong Chen, Ivan Marsic, Fei Tao, Dawei Wang, Omar Z. Ahmed, Randall S BurdAbstract:In this study, we present a framework for analyzing associations between patient cohorts and the Trauma Resuscitation procedures their patients received. Our framework works by quantifying associations between discovered patient cohorts and treatment patterns. We evaluated our framework on a Trauma Resuscitation dataset collected in a level 1 Trauma center. Our experimental results show that using weights learned by our algorithm improves measurements of patient similarity. Four patient cohorts were then found via clustering, and statistically significant Resuscitation patterns were discovered using process mining techniques. Though only tested on the Trauma Resuscitation process, our framework can be generalized to analyze other medical processes.
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ICHI - Language-Based Process Phase Detection in the Trauma Resuscitation
IEEE International Conference on Healthcare Informatics. IEEE International Conference on Healthcare Informatics, 2017Co-Authors: Shuhong Chen, Ivan Marsic, Richard A. Farneth, Randall S BurdAbstract:Process phase detection has been widely used in surgical process modeling (SPM) to track process progression. These studies mostly used video and embedded sensor data, but spoken language also provides rich semantic information directly related to process progression. We present a long-short term memory (LSTM) deep learning model to predict Trauma Resuscitation phases using verbal communication logs. We first use an LSTM to extract the sentence meaning representations, and then sequentially feed them into another LSTM to extract the mean-ing of a sentence group within a time window. This information is ultimately used for phase prediction. We used 24 manually-transcribed Trauma Resuscitation cases to train, and the remain-ing 6 cases to test our model. We achieved 79.12% accuracy, and showed performance advantages over existing visual-audio systems for critical phases of the process. In addition to language information, we evaluated a multimodal phase prediction structure that also uses audio input. We finally identified the challenges of substituting manual transcription with automatic speech recognition in Trauma Resuscitation.
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Trauma Resuscitation: can team behaviours in the prearrival period predict Resuscitation performance?
BMJ Simulation and Technology Enhanced Learning, 2017Co-Authors: Seth A. Kaplan, Randall S Burd, Carolyn J. Winslow, Amber K. Hargrove, Mary J. WallerAbstract:Background Optimising team performance is critical in paediatric Trauma Resuscitation. Previous studies in aviation and surgery link performance to behaviours in the prearrival period. Objective To determine if patterns of human behaviour in the prearrival period of a simulated Trauma Resuscitation is predictive of Resuscitation performance. Design Twelve volunteer Trauma teams performed in four simulation scenarios in a paediatric hospital. The scenarios were video recorded, transcribed and analysed in 10-second intervals. Variation in the amount of utterances per team member in the prearrival period was compared with team performance and implicit coordination during the Resuscitation. Key results Coders analysed 18 962 s of video. They coded 5204 team member utterances into one of eight communication behaviour categories. Inter-rater reliability was excellent (an average of 83.1% across all four scenarios). The average number of communications occurring during the prearrival period was 18.84 utterances, with a range of 2–42 and a SD of 9.55. The average length of this period was almost 2 minutes (mean =117.30 s, SD=39.20). Lower variance in team member communication during the prearrival better was associated with better implicit coordination (p=0.011) but not team performance (p=0.054) during the Resuscitation. Conclusion Patterns of communication in the prearrival Trauma Resuscitation period predicted implicit coordination and a trend towards significance for team performance which suggests further studies in such patterns are warranted.
Aleksandra Sarcevic - One of the best experts on this subject based on the ideXlab platform.
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ICHI - Intention Mining in Medical Process: A Case Study in Trauma Resuscitation
IEEE International Conference on Healthcare Informatics. IEEE International Conference on Healthcare Informatics, 2018Co-Authors: Sen Yang, Aleksandra Sarcevic, Shuhong Chen, Ivan Marsic, Richard A. Farneth, Xin Dong, Randall S BurdAbstract:In medical processes such as surgical procedures and Trauma Resuscitations, medical teams perform treatment activities according to underlying invisible goals or intentions. In this study, we presented an approach to uncover these intentions from observed treatment activities. Developed on top of a hierarchical hidden Markov model (H-HMM), our approach can identify multi-level intentions. To accurately infer the H-HMM, we used state splitting method with maximum a posteriori probability (MAP) as the scoring function. We evaluated our approach in both qualitative and quantitative ways, using a case study of the Trauma Resuscitation process. This dataset includes 123 Trauma Resuscitation cases collected at a level 1 Trauma center. Our results show our intention mining achieved an accuracy of 86.6% in classifying medical teams' intentions. This work shows the feasibility of unsupervised intention mining of complex real-world medical processes.
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Passive RFID for Object and Use Detection during Trauma Resuscitation
IEEE Transactions on Mobile Computing, 2016Co-Authors: Siddika Parlak, Aleksandra Sarcevic, Lauren J. Waterhouse, Iva Marsic, Waheed U. Ajwa, Randall S. UrdAbstract:We evaluated passive radio-frequency identification (RFID) technology for detecting the use of objects and related activities during Trauma Resuscitation. Our system consists of RFID tags and antennas, optimally placed for object detection, as well as algorithms for processing RFID data to infer object use. To evaluate our approach, we tagged 81 objects in the Resuscitation room and recorded RFID signal strength during 32 simulated Resuscitations performed by Trauma teams. We then analyzed RFID data to identify cues for recognizing Resuscitation activities. Using these cues, we extracted descriptive features and applied machine-learning techniques to monitor interactions with objects. Our results show that an instance of a used object can be detected with accuracy rates greater than 90 percent in a crowded and fast-paced medical setting using off-the-shelf RFID equipment, and the time and duration of use can be identified with up to 83 percent accuracy. We conclude with insights into the limitations of passive RFID and areas in which RFID needs to be complemented with other sensing technologies.
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Classification and team response to nonroutine events occurring during pediatric Trauma Resuscitation.
The journal of trauma and acute care surgery, 2016Co-Authors: Rachel B. Webman, Aleksandra Sarcevic, Sarah Henrickson Parker, Ivan Marsic, Jennifer L. Fritzeen, Jaewon Yang, Paul C. Mullan, Faisal G. Qureshi, Randall S BurdAbstract:BACKGROUND Errors directly causing serious harm are rare during pediatric Trauma Resuscitation, limiting the use of adverse outcome analysis for performance improvement in this setting. Errors not causing harm because of mitigation or chance may have similar causation and are more frequent than those causing adverse outcomes. Analyzing these error types is an alternative to adverse outcome analysis. The purpose of this study was to identify errors of any type during pediatric Trauma Resuscitation and evaluate team responses to their occurrence. METHODS Errors identified using video analysis were classified as errors of omission or commission and selection errors using input from Trauma experts. The responses to error types and error frequency based on patient and event features were compared. RESULTS Thirty-nine Resuscitations were reviewed, identifying 337 errors (range, 2-26 per Resuscitation). The most common errors were related to cervical spine stabilization (n = 93, 27.6%). Errors of omission (n = 135) and commission (n = 106) were more common than errors of selection (n = 96). Although 35.9% of all errors were acknowledged and compensation occurred after 43.6%, no response (acknowledgement or compensation) was observed after 51.3% of errors. Errors of omission and commission were more often acknowledged (40.7% and 39.6% vs. 25.0%, p = 0.03 and p = 0.04, respectively) and compensated for (50.4% and 47.2% vs. 29.2%, p = 0.004 and p = 0.01, respectively) than selection errors. Response differences between errors of omission and commission were not observed. The number of errors and the number of high-risk errors that occurred did not differ based on patient or event features. CONCLUSIONS Errors are common during pediatric Trauma Resuscitation. Teams did not respond to most errors, although differences in team response were observed between error types. Determining causation of errors may be an approach for identifying latent safety threats contributing to adverse outcomes during pediatric Trauma Resuscitation. LEVEL OF EVIDENCE Therapeutic study, level III.
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Improving ATLS performance in simulated pediatric Trauma Resuscitation using a checklist.
Annals of surgery, 2014Co-Authors: Samantha E. Parsons, Aleksandra Sarcevic, Deirdre C. Kelleher, Lauren J. Waterhouse, Elizabeth A. Carter, Jennifer L. Fritzeen, Karen J. Oʼconnell, Kelley M. Baker, Erik T. Nelson, Nicole E. WernerAbstract:OBJECTIVE To develop a checklist for use during pediatric Trauma Resuscitation and test its effectiveness during simulated Resuscitations. BACKGROUND Checklists have been used to support a wide range of complex medical activities and have effectively reduced errors and improved outcomes in different medical settings. Checklists have not been evaluated in the domain of Trauma Resuscitation. METHODS A focus group of Trauma specialists was organized to develop a checklist for pediatric Trauma Resuscitation. This checklist was then tested in simulated Trauma Resuscitations to evaluate its impact on team performance. Resuscitations conducted with and without the checklist were compared using the Advanced Trauma Life Support (ATLS) performance score, designed to measure adherence to ATLS protocol, and surveys of team members' subjective workload. RESULTS The focus group generated a checklist with 56 items divided into 5 sections corresponding to different phases of Trauma Resuscitation. In simulation testing, the total ATLS performance score was 4.9 points higher with a checklist than without (P < 0.001), with most of this difference related to improvement in performance of the secondary survey (+3.3 points, P < 0.001). Overall, workload scores were not affected by the addition of the checklist. CONCLUSIONS Implementing a checklist during simulated pediatric Trauma Resuscitation improves adherence to the ATLS protocol without increasing the workload of Trauma team members.
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A prototype system for heterogeneous data management and medical devices integration in Trauma Resuscitation
2013Co-Authors: Zhan Zhang, Aleksandra SarcevicAbstract:We propose a system for information acquisition, integration and presentation to support situation awareness during Trauma Resuscitation. The system consists of (a) medical devices for data acquisition, (b) a database and middleware applications for storing and processing data, and (c) a computer coupled with a large wall display for data presentation. We discuss the initial design of this system and the planned evaluation and implementation steps in the future.
Lauren J. Waterhouse - One of the best experts on this subject based on the ideXlab platform.
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Passive RFID for Object and Use Detection during Trauma Resuscitation
IEEE Transactions on Mobile Computing, 2016Co-Authors: Siddika Parlak, Aleksandra Sarcevic, Lauren J. Waterhouse, Iva Marsic, Waheed U. Ajwa, Randall S. UrdAbstract:We evaluated passive radio-frequency identification (RFID) technology for detecting the use of objects and related activities during Trauma Resuscitation. Our system consists of RFID tags and antennas, optimally placed for object detection, as well as algorithms for processing RFID data to infer object use. To evaluate our approach, we tagged 81 objects in the Resuscitation room and recorded RFID signal strength during 32 simulated Resuscitations performed by Trauma teams. We then analyzed RFID data to identify cues for recognizing Resuscitation activities. Using these cues, we extracted descriptive features and applied machine-learning techniques to monitor interactions with objects. Our results show that an instance of a used object can be detected with accuracy rates greater than 90 percent in a crowded and fast-paced medical setting using off-the-shelf RFID equipment, and the time and duration of use can be identified with up to 83 percent accuracy. We conclude with insights into the limitations of passive RFID and areas in which RFID needs to be complemented with other sensing technologies.
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effect of a checklist on advanced Trauma life support task performance during pediatric Trauma Resuscitation
Academic Emergency Medicine, 2014Co-Authors: Deirdre C. Kelleher, Lauren J. Waterhouse, Elizabeth A. Carter, Samantha E. Parsons, Jennifer L. Fritzeen, Randall S BurdAbstract:OBJECTIVES: Advanced Trauma Life Support (ATLS) has been shown to improve outcomes related to Trauma Resuscitation; however, omissions from this protocol persist. The objective of this study was to evaluate the effect of a Trauma Resuscitation checklist on performance of ATLS tasks. METHODS: Video recordings of Resuscitations of children sustaining blunt or penetrating injuries at a Level I pediatric Trauma center were reviewed for completion and timeliness of ATLS primary and secondary survey tasks, with and without checklist use. Patient and Resuscitation characteristics were obtained from the Trauma registry. Data were collected during two 4-month periods before (n = 222) and after (n = 213) checklist implementation. The checklist contained 50 items and included four sections: prearrival, primary survey, secondary survey, and departure plan. RESULTS: Five primary survey ATLS tasks (cervical spine immobilization, oxygen administration, palpating pulses, assessing neurologic status, and exposing the patient) and nine secondary survey ATLS tasks were performed more frequently (p ≤ 0.01 for all) and vital sign measurements were obtained faster (p ≤ 0.01 for all) after the checklist was implemented. When controlling for patient and event-specific characteristics, primary and secondary survey tasks overall were more likely to be completed (odds ratio [OR] = 2.66, primary survey; OR = 2.47, secondary survey; p CONCLUSIONS: Implementation of a Trauma checklist was associated with greater ATLS task performance and with increased frequency and speed of primary and secondary survey task completion. Language: en
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Factors affecting team size and task performance in pediatric Trauma Resuscitation.
Pediatric Emergency Care, 2014Co-Authors: Deirdre C. Kelleher, Mark L. Kovler, Lauren J. Waterhouse, Elizabeth A. Carter, Randall S BurdAbstract:OBJECTIVES: Varying team size based on anticipated injury acuity is a common method for limiting personnel during Trauma Resuscitation. While missing personnel may delay treatment, large teams may worsen care through role confusion and interference. This study investigates factors associated with varying team size and task completion during Trauma Resuscitation. METHODS: Video-recorded Resuscitations of pediatric Trauma patients (n = 201) were reviewed for team size (bedside and total) and completion of 24 Resuscitation tasks. Additional patient characteristics were abstracted from our Trauma registry. Linear regression was used to assess which characteristics were associated with varying team size and task completion. Task completion was then analyzed in relation to team size using best-fit curves. RESULTS: The average bedside team ranged from 2.7 to 10.0 members (mean, 6.5 [SD, 1.7]), with 4.3 to 17.7 (mean, 11.0 [SD, 2.8]) people total. More people were present during high-acuity activations (+4.9, P CONCLUSIONS: Resuscitation task completion varies by team size, with a nonlinear association between number of team members and completed tasks. Management of team size during high-acuity activations, those without prior notification, and those in which the patient has a penetrating injury may help optimize performance. Language: en
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Improving ATLS performance in simulated pediatric Trauma Resuscitation using a checklist.
Annals of surgery, 2014Co-Authors: Samantha E. Parsons, Aleksandra Sarcevic, Deirdre C. Kelleher, Lauren J. Waterhouse, Elizabeth A. Carter, Jennifer L. Fritzeen, Karen J. Oʼconnell, Kelley M. Baker, Erik T. Nelson, Nicole E. WernerAbstract:OBJECTIVE To develop a checklist for use during pediatric Trauma Resuscitation and test its effectiveness during simulated Resuscitations. BACKGROUND Checklists have been used to support a wide range of complex medical activities and have effectively reduced errors and improved outcomes in different medical settings. Checklists have not been evaluated in the domain of Trauma Resuscitation. METHODS A focus group of Trauma specialists was organized to develop a checklist for pediatric Trauma Resuscitation. This checklist was then tested in simulated Trauma Resuscitations to evaluate its impact on team performance. Resuscitations conducted with and without the checklist were compared using the Advanced Trauma Life Support (ATLS) performance score, designed to measure adherence to ATLS protocol, and surveys of team members' subjective workload. RESULTS The focus group generated a checklist with 56 items divided into 5 sections corresponding to different phases of Trauma Resuscitation. In simulation testing, the total ATLS performance score was 4.9 points higher with a checklist than without (P < 0.001), with most of this difference related to improvement in performance of the secondary survey (+3.3 points, P < 0.001). Overall, workload scores were not affected by the addition of the checklist. CONCLUSIONS Implementing a checklist during simulated pediatric Trauma Resuscitation improves adherence to the ATLS protocol without increasing the workload of Trauma team members.
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Factors associated with patient exposure and environmental control during pediatric Trauma Resuscitation.
The journal of trauma and acute care surgery, 2013Co-Authors: Deirdre C. Kelleher, Randall S Burd, Lauren J. Waterhouse, Samantha E. Parsons, Jennifer L. Fritzeen, Elizabeth A. CarterAbstract:BACKGROUND Exposure and environmental control are essential components of the advanced Trauma life support primary survey, especially during the Resuscitation of pediatric patients. Proper exposure aids in early recognition of injuries in patients unable to communicate their injuries, while warming techniques, such as the use of blankets, assist in maintaining normothermia. The purpose of this study was to identify factors associated with exposure compliance and duration during pediatric Trauma Resuscitation. METHODS All pediatric Trauma Resuscitations over a 4-month period were reviewed for compliance and time to completion of clothing removal and warm blanket placement. Video review data were then linked with clinical data obtained from the Trauma registry. Univariate and multivariate analyses were used to determine the associations of patient characteristics, injury mechanism, and clinical factors on exposure compliance and duration. RESULTS Of 145 patients, 65 (52%) were never exposed. Lower exposure compliance was associated with increasing age (odds ratio, [OR], 0.90; 95% confidence interval [CI], 0.83-0.98), Glasgow Coma Scale (GCS) score of 14 or greater (OR, 0.16; 95% CI, 0.03-0.76), Injury Severity Score (ISS) of 15 or less (OR, 0.27; 95% CI, 0.09-0.82), and the absence of head injury (OR, 0.26; 95% CI, 0.08-0.87). Among those exposed, the duration of exposure was longer among children with GCS score of less than 14 (4.3 [1.6], p = 0.009), head injuries (3.33 [1.6], p = 0.04), and the need for intubation (8.4 [2.2], p < 0.001). In multivariate analyses, older age and ISS of 15 or less were associated with a decreased odds of exposure (p = 0.009, p = 0.04, respectively), while intubation was associated with increased exposure duration (p = 0.007). CONCLUSION Despite the importance of exposure and environmental control during pediatric Trauma Resuscitation, compliance with these tasks was low, even among severely injured patients. Interventions are needed to promote the proper exposure of patients during the initial evaluation, while also limiting the duration of exposure during examinations and procedures in the Trauma bay. LEVEL OF EVIDENCE Epidemiologic study, level III.
Samantha E. Parsons - One of the best experts on this subject based on the ideXlab platform.
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effect of a checklist on advanced Trauma life support task performance during pediatric Trauma Resuscitation
Academic Emergency Medicine, 2014Co-Authors: Deirdre C. Kelleher, Lauren J. Waterhouse, Elizabeth A. Carter, Samantha E. Parsons, Jennifer L. Fritzeen, Randall S BurdAbstract:OBJECTIVES: Advanced Trauma Life Support (ATLS) has been shown to improve outcomes related to Trauma Resuscitation; however, omissions from this protocol persist. The objective of this study was to evaluate the effect of a Trauma Resuscitation checklist on performance of ATLS tasks. METHODS: Video recordings of Resuscitations of children sustaining blunt or penetrating injuries at a Level I pediatric Trauma center were reviewed for completion and timeliness of ATLS primary and secondary survey tasks, with and without checklist use. Patient and Resuscitation characteristics were obtained from the Trauma registry. Data were collected during two 4-month periods before (n = 222) and after (n = 213) checklist implementation. The checklist contained 50 items and included four sections: prearrival, primary survey, secondary survey, and departure plan. RESULTS: Five primary survey ATLS tasks (cervical spine immobilization, oxygen administration, palpating pulses, assessing neurologic status, and exposing the patient) and nine secondary survey ATLS tasks were performed more frequently (p ≤ 0.01 for all) and vital sign measurements were obtained faster (p ≤ 0.01 for all) after the checklist was implemented. When controlling for patient and event-specific characteristics, primary and secondary survey tasks overall were more likely to be completed (odds ratio [OR] = 2.66, primary survey; OR = 2.47, secondary survey; p CONCLUSIONS: Implementation of a Trauma checklist was associated with greater ATLS task performance and with increased frequency and speed of primary and secondary survey task completion. Language: en
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Improving ATLS performance in simulated pediatric Trauma Resuscitation using a checklist.
Annals of surgery, 2014Co-Authors: Samantha E. Parsons, Aleksandra Sarcevic, Deirdre C. Kelleher, Lauren J. Waterhouse, Elizabeth A. Carter, Jennifer L. Fritzeen, Karen J. Oʼconnell, Kelley M. Baker, Erik T. Nelson, Nicole E. WernerAbstract:OBJECTIVE To develop a checklist for use during pediatric Trauma Resuscitation and test its effectiveness during simulated Resuscitations. BACKGROUND Checklists have been used to support a wide range of complex medical activities and have effectively reduced errors and improved outcomes in different medical settings. Checklists have not been evaluated in the domain of Trauma Resuscitation. METHODS A focus group of Trauma specialists was organized to develop a checklist for pediatric Trauma Resuscitation. This checklist was then tested in simulated Trauma Resuscitations to evaluate its impact on team performance. Resuscitations conducted with and without the checklist were compared using the Advanced Trauma Life Support (ATLS) performance score, designed to measure adherence to ATLS protocol, and surveys of team members' subjective workload. RESULTS The focus group generated a checklist with 56 items divided into 5 sections corresponding to different phases of Trauma Resuscitation. In simulation testing, the total ATLS performance score was 4.9 points higher with a checklist than without (P < 0.001), with most of this difference related to improvement in performance of the secondary survey (+3.3 points, P < 0.001). Overall, workload scores were not affected by the addition of the checklist. CONCLUSIONS Implementing a checklist during simulated pediatric Trauma Resuscitation improves adherence to the ATLS protocol without increasing the workload of Trauma team members.
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Factors associated with patient exposure and environmental control during pediatric Trauma Resuscitation.
The journal of trauma and acute care surgery, 2013Co-Authors: Deirdre C. Kelleher, Randall S Burd, Lauren J. Waterhouse, Samantha E. Parsons, Jennifer L. Fritzeen, Elizabeth A. CarterAbstract:BACKGROUND Exposure and environmental control are essential components of the advanced Trauma life support primary survey, especially during the Resuscitation of pediatric patients. Proper exposure aids in early recognition of injuries in patients unable to communicate their injuries, while warming techniques, such as the use of blankets, assist in maintaining normothermia. The purpose of this study was to identify factors associated with exposure compliance and duration during pediatric Trauma Resuscitation. METHODS All pediatric Trauma Resuscitations over a 4-month period were reviewed for compliance and time to completion of clothing removal and warm blanket placement. Video review data were then linked with clinical data obtained from the Trauma registry. Univariate and multivariate analyses were used to determine the associations of patient characteristics, injury mechanism, and clinical factors on exposure compliance and duration. RESULTS Of 145 patients, 65 (52%) were never exposed. Lower exposure compliance was associated with increasing age (odds ratio, [OR], 0.90; 95% confidence interval [CI], 0.83-0.98), Glasgow Coma Scale (GCS) score of 14 or greater (OR, 0.16; 95% CI, 0.03-0.76), Injury Severity Score (ISS) of 15 or less (OR, 0.27; 95% CI, 0.09-0.82), and the absence of head injury (OR, 0.26; 95% CI, 0.08-0.87). Among those exposed, the duration of exposure was longer among children with GCS score of less than 14 (4.3 [1.6], p = 0.009), head injuries (3.33 [1.6], p = 0.04), and the need for intubation (8.4 [2.2], p < 0.001). In multivariate analyses, older age and ISS of 15 or less were associated with a decreased odds of exposure (p = 0.009, p = 0.04, respectively), while intubation was associated with increased exposure duration (p = 0.007). CONCLUSION Despite the importance of exposure and environmental control during pediatric Trauma Resuscitation, compliance with these tasks was low, even among severely injured patients. Interventions are needed to promote the proper exposure of patients during the initial evaluation, while also limiting the duration of exposure during examinations and procedures in the Trauma bay. LEVEL OF EVIDENCE Epidemiologic study, level III.
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Assessment of workload during pediatric Trauma Resuscitation.
The journal of trauma and acute care surgery, 2012Co-Authors: Samantha E. Parsons, Aleksandra Sarcevic, Lauren J. Waterhouse, Elizabeth A. Carter, Karen J. O'connell, Randall S BurdAbstract:BACKGROUND Trauma Resuscitations are high-pressure, time-critical events during which health care providers form ad hoc teams to rapidly assess and treat injured patients. Trauma team members experience varying levels of workload during Resuscitations resulting from the objective demands of their role-specific tasks, the circumstances surrounding the event, and their individual previous experiences. The goal of this study was to determine factors influencing workload experienced by Trauma team members during pediatric Trauma Resuscitations. METHODS Workload was measured using the National Aeronautics and Space Administration Task Load Index (TLX). TLX surveys were administered to four Trauma team roles: charge nurse, senior surgical resident (surgical coordinator), emergency medicine physician, and junior surgical resident or nurse practitioner (bedside clinician). A total of 217 surveys were completed. Univariate and multivariate statistical techniques were used to examine the relationship between workload and patient and clinical factors. RESULTS Bedside clinicians reported the highest total workload score (208.7), followed by emergency medicine physicians (156.3), surgical coordinators (144.1), and charge nurses (129.1). Workload was higher during higher-level activations (235.3), for events involving intubated patients (249.0), and for patients with an Injury Severity Score greater than 15 (230.4) (p, 0.001 for all). When controlling for potential confounders using multiple linear regression, workload was increased during higher level activations (79.0 points higher, p = 0.01) and events without previous notification (38.9 points higher, p = 0.03). Workload also remained significantly higher for the bedside clinician compared with the other three roles (p ≤ 0.005 for all). CONCLUSION Workload during pediatric Trauma Resuscitations differed by team role and was increased for higher-level activations and events without previous notification. This study demonstrates the validity of the TLX as a tool to measure workload in Trauma Resuscitation. LEVEL OF EVIDENCE Prognostic study, level II.
Elizabeth A. Carter - One of the best experts on this subject based on the ideXlab platform.
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effect of a checklist on advanced Trauma life support task performance during pediatric Trauma Resuscitation
Academic Emergency Medicine, 2014Co-Authors: Deirdre C. Kelleher, Lauren J. Waterhouse, Elizabeth A. Carter, Samantha E. Parsons, Jennifer L. Fritzeen, Randall S BurdAbstract:OBJECTIVES: Advanced Trauma Life Support (ATLS) has been shown to improve outcomes related to Trauma Resuscitation; however, omissions from this protocol persist. The objective of this study was to evaluate the effect of a Trauma Resuscitation checklist on performance of ATLS tasks. METHODS: Video recordings of Resuscitations of children sustaining blunt or penetrating injuries at a Level I pediatric Trauma center were reviewed for completion and timeliness of ATLS primary and secondary survey tasks, with and without checklist use. Patient and Resuscitation characteristics were obtained from the Trauma registry. Data were collected during two 4-month periods before (n = 222) and after (n = 213) checklist implementation. The checklist contained 50 items and included four sections: prearrival, primary survey, secondary survey, and departure plan. RESULTS: Five primary survey ATLS tasks (cervical spine immobilization, oxygen administration, palpating pulses, assessing neurologic status, and exposing the patient) and nine secondary survey ATLS tasks were performed more frequently (p ≤ 0.01 for all) and vital sign measurements were obtained faster (p ≤ 0.01 for all) after the checklist was implemented. When controlling for patient and event-specific characteristics, primary and secondary survey tasks overall were more likely to be completed (odds ratio [OR] = 2.66, primary survey; OR = 2.47, secondary survey; p CONCLUSIONS: Implementation of a Trauma checklist was associated with greater ATLS task performance and with increased frequency and speed of primary and secondary survey task completion. Language: en
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Factors affecting team size and task performance in pediatric Trauma Resuscitation.
Pediatric Emergency Care, 2014Co-Authors: Deirdre C. Kelleher, Mark L. Kovler, Lauren J. Waterhouse, Elizabeth A. Carter, Randall S BurdAbstract:OBJECTIVES: Varying team size based on anticipated injury acuity is a common method for limiting personnel during Trauma Resuscitation. While missing personnel may delay treatment, large teams may worsen care through role confusion and interference. This study investigates factors associated with varying team size and task completion during Trauma Resuscitation. METHODS: Video-recorded Resuscitations of pediatric Trauma patients (n = 201) were reviewed for team size (bedside and total) and completion of 24 Resuscitation tasks. Additional patient characteristics were abstracted from our Trauma registry. Linear regression was used to assess which characteristics were associated with varying team size and task completion. Task completion was then analyzed in relation to team size using best-fit curves. RESULTS: The average bedside team ranged from 2.7 to 10.0 members (mean, 6.5 [SD, 1.7]), with 4.3 to 17.7 (mean, 11.0 [SD, 2.8]) people total. More people were present during high-acuity activations (+4.9, P CONCLUSIONS: Resuscitation task completion varies by team size, with a nonlinear association between number of team members and completed tasks. Management of team size during high-acuity activations, those without prior notification, and those in which the patient has a penetrating injury may help optimize performance. Language: en
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Improving ATLS performance in simulated pediatric Trauma Resuscitation using a checklist.
Annals of surgery, 2014Co-Authors: Samantha E. Parsons, Aleksandra Sarcevic, Deirdre C. Kelleher, Lauren J. Waterhouse, Elizabeth A. Carter, Jennifer L. Fritzeen, Karen J. Oʼconnell, Kelley M. Baker, Erik T. Nelson, Nicole E. WernerAbstract:OBJECTIVE To develop a checklist for use during pediatric Trauma Resuscitation and test its effectiveness during simulated Resuscitations. BACKGROUND Checklists have been used to support a wide range of complex medical activities and have effectively reduced errors and improved outcomes in different medical settings. Checklists have not been evaluated in the domain of Trauma Resuscitation. METHODS A focus group of Trauma specialists was organized to develop a checklist for pediatric Trauma Resuscitation. This checklist was then tested in simulated Trauma Resuscitations to evaluate its impact on team performance. Resuscitations conducted with and without the checklist were compared using the Advanced Trauma Life Support (ATLS) performance score, designed to measure adherence to ATLS protocol, and surveys of team members' subjective workload. RESULTS The focus group generated a checklist with 56 items divided into 5 sections corresponding to different phases of Trauma Resuscitation. In simulation testing, the total ATLS performance score was 4.9 points higher with a checklist than without (P < 0.001), with most of this difference related to improvement in performance of the secondary survey (+3.3 points, P < 0.001). Overall, workload scores were not affected by the addition of the checklist. CONCLUSIONS Implementing a checklist during simulated pediatric Trauma Resuscitation improves adherence to the ATLS protocol without increasing the workload of Trauma team members.
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Factors associated with patient exposure and environmental control during pediatric Trauma Resuscitation.
The journal of trauma and acute care surgery, 2013Co-Authors: Deirdre C. Kelleher, Randall S Burd, Lauren J. Waterhouse, Samantha E. Parsons, Jennifer L. Fritzeen, Elizabeth A. CarterAbstract:BACKGROUND Exposure and environmental control are essential components of the advanced Trauma life support primary survey, especially during the Resuscitation of pediatric patients. Proper exposure aids in early recognition of injuries in patients unable to communicate their injuries, while warming techniques, such as the use of blankets, assist in maintaining normothermia. The purpose of this study was to identify factors associated with exposure compliance and duration during pediatric Trauma Resuscitation. METHODS All pediatric Trauma Resuscitations over a 4-month period were reviewed for compliance and time to completion of clothing removal and warm blanket placement. Video review data were then linked with clinical data obtained from the Trauma registry. Univariate and multivariate analyses were used to determine the associations of patient characteristics, injury mechanism, and clinical factors on exposure compliance and duration. RESULTS Of 145 patients, 65 (52%) were never exposed. Lower exposure compliance was associated with increasing age (odds ratio, [OR], 0.90; 95% confidence interval [CI], 0.83-0.98), Glasgow Coma Scale (GCS) score of 14 or greater (OR, 0.16; 95% CI, 0.03-0.76), Injury Severity Score (ISS) of 15 or less (OR, 0.27; 95% CI, 0.09-0.82), and the absence of head injury (OR, 0.26; 95% CI, 0.08-0.87). Among those exposed, the duration of exposure was longer among children with GCS score of less than 14 (4.3 [1.6], p = 0.009), head injuries (3.33 [1.6], p = 0.04), and the need for intubation (8.4 [2.2], p < 0.001). In multivariate analyses, older age and ISS of 15 or less were associated with a decreased odds of exposure (p = 0.009, p = 0.04, respectively), while intubation was associated with increased exposure duration (p = 0.007). CONCLUSION Despite the importance of exposure and environmental control during pediatric Trauma Resuscitation, compliance with these tasks was low, even among severely injured patients. Interventions are needed to promote the proper exposure of patients during the initial evaluation, while also limiting the duration of exposure during examinations and procedures in the Trauma bay. LEVEL OF EVIDENCE Epidemiologic study, level III.
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Assessment of workload during pediatric Trauma Resuscitation.
The journal of trauma and acute care surgery, 2012Co-Authors: Samantha E. Parsons, Aleksandra Sarcevic, Lauren J. Waterhouse, Elizabeth A. Carter, Karen J. O'connell, Randall S BurdAbstract:BACKGROUND Trauma Resuscitations are high-pressure, time-critical events during which health care providers form ad hoc teams to rapidly assess and treat injured patients. Trauma team members experience varying levels of workload during Resuscitations resulting from the objective demands of their role-specific tasks, the circumstances surrounding the event, and their individual previous experiences. The goal of this study was to determine factors influencing workload experienced by Trauma team members during pediatric Trauma Resuscitations. METHODS Workload was measured using the National Aeronautics and Space Administration Task Load Index (TLX). TLX surveys were administered to four Trauma team roles: charge nurse, senior surgical resident (surgical coordinator), emergency medicine physician, and junior surgical resident or nurse practitioner (bedside clinician). A total of 217 surveys were completed. Univariate and multivariate statistical techniques were used to examine the relationship between workload and patient and clinical factors. RESULTS Bedside clinicians reported the highest total workload score (208.7), followed by emergency medicine physicians (156.3), surgical coordinators (144.1), and charge nurses (129.1). Workload was higher during higher-level activations (235.3), for events involving intubated patients (249.0), and for patients with an Injury Severity Score greater than 15 (230.4) (p, 0.001 for all). When controlling for potential confounders using multiple linear regression, workload was increased during higher level activations (79.0 points higher, p = 0.01) and events without previous notification (38.9 points higher, p = 0.03). Workload also remained significantly higher for the bedside clinician compared with the other three roles (p ≤ 0.005 for all). CONCLUSION Workload during pediatric Trauma Resuscitations differed by team role and was increased for higher-level activations and events without previous notification. This study demonstrates the validity of the TLX as a tool to measure workload in Trauma Resuscitation. LEVEL OF EVIDENCE Prognostic study, level II.
