Transcript Improving Pediatric Trauma poster-LARISSA ZELI

Improving Pediatric Trauma: An introduction to role-tagging and
role coordination within the trauma bay
Larissa Zeli, RN, BSN, CPEN, Jeffery Beveridge, RN, BSN, CPEN, Cassandra Rennick, RN, BSN, CPEN, & Cheryl Martin, RN, BSN, CPN
Purpose:
Pediatric trauma resuscitation requires communication between members of
a multidisciplinary trauma team in a time-critical, dynamic environment in
order to rapidly stabilize life-threatening injuries. Over-convergence of staff
during severe trauma commonly and inadvertently leads to communication
barriers and role confusion. Recent literature states that Children’s National
Medical Center, a Level 1 pediatric trauma center in a major pediatric
teaching hospital, recently implemented the use of self-adhesive, pre-printed
tags during trauma resuscitation, which showed promise in the concept of
role-tagging [1,2].
The aim of this quality improvement project is to utilize a role-tagging system
using a color-coded approach within the trauma bay during Level 1 pediatric
trauma resuscitations to:
improve teamwork and collaboration,
strengthen communication,
facilitate role identification between team members
Limit access into trauma bay to those with active role
Setting/Utilization Framework:
This quality improvement project was implemented in Children’s Hospital of
Pittsburgh’s Emergency Department, a Level 1 pediatric trauma center.
Collaboratively, the hospital’s Emergency Department and Bandeau Trauma
Program, the hospital’s formal trauma program headed by Children’s Hospital
of Pittsburgh’s Pediatric Surgery department, developed a role tagging system
to address communication barriers during pediatric trauma resuscitation,
including over-convergence and lack of ability to distinguish individual team
members and their role in patient care.
Strategies:
Instead of the institution’s standardized blue protective barrier gowns worn by all team
members during trauma resuscitation, four different colors of protective barrier gowns were
utilized as our method for role identification. Roles were assigned a specific color of
protective barrier gown in order to differentiate team members, categorized by leadership
(white), physician (blue), nursing (yellow), and ancillary staff (green).
Methods:
Allotments were distributed based on task-specific duties within each role (2 leadership, 6
physician, 4 nursing, and 3 ancillary staff) in order to limit the number of staff members
within the trauma bay.
2 Leadership (White)
1. Command Physician
2. ED Clinical Leader
6 Physician (Blue)
1. PEM Attending
2. Assisting Emergency Medicine
3. Trauma Surgery Attending
4. Assisting Surgery
5. Airway Management
6. Airway Backup
4 Nursing (Yellow)
1. ED RN: Right
2. ED RN: Left
3. ED RN: Medication
4. ED RN: Documentation
Barriers:
Barriers were experienced throughout the process of implementing the colorbased role-tagging quality improvement project. A large barrier to
implementing the color-based role system involved obtaining gowns suitable
for the purpose of level 1 trauma resuscitation. Difficulties were encountered
in locating a company who offered four separate colors of protective gowns.
After locating a company who offered four different colors of protective
gowns, the gowns were then trialed before utilizing them for patient care. It
was determined the gowns were not waterproof, which made them
unacceptable for use in trauma resuscitation settings.
Another barrier considered by the team in regards to the limitation of staff
within the trauma bay related to our institution as a teaching hospital.
Although staff access within the trauma bay is limited to those with an active,
defined role in the trauma resuscitation, our trauma bays were designed with
glass doors which allow for visualization of the trauma resuscitation from
outside of the trauma bay. In addition, video documentation is obtained on all
Level 1 trauma resuscitations which can be reviewed.
3 Ancillary (Green)
1. ED PCT
2. Respiratory Therapist
3. Radiology Technician
Doors to the trauma bay
are glass and overhead
video documentation
allows for learning
experience from outside
the trauma bay.
Responding staff members without specified roles are required to observe from outside of the
trauma bay, unless directed to assist at bedside by the Command physician
A future barrier likely to be encountered during final implementation of this
quality improvement project is compliance. Compliance must be taken into
consideration with implementation of any new process, and certain factors
such as a critically injured patient or little notification prior to arrival may
decrease compliance of the system.
Children’s Hospital of Pittsburgh’s Emergency Department contains three
separate trauma bays each of which are fully equipped for Level 1 trauma
resuscitation. Upon notification via UPMC MedCall paging system of
incoming Level 1 trauma, a multidisciplinary trauma team rapidly assembles
within the trauma bay. Each team member’s attendance is documented
electronically using electronic staff identification badge swiping system
located just outside each trauma bay. In order to increase compliance, device
which flash red lights during trauma resuscitation were installed directly
above the badge swiping system.
Evaluation and Outcomes:
The projected outcomes of role-tagging within the trauma bay are:
1.) Improved identification of individual team members and their specific
roles and tasks within the resuscitation,
2.) Strengthened communication and collaboration between trauma team
members, and
3.) Limited access within the trauma bay to team members having an active
role in the trauma resuscitation
Video Documentation System:
Button Activation and
Overhead Video Camera
Identification Badge
Swiping System
Protective
Equipment Stored in
Rolling Carts
Level 1: Protective Gown,
Protective Eyewear, Face
Mask, & Gloves
All staff members who respond to level 1 trauma are required to be wearing
protective gear consisting of a protective gown, face mask, gloves, and
protective eyewear. The standardized protective gowns worn during trauma
resuscitation were blue prior to the implementation of this quality
improvement project, and serve as the means for our color-coded role-tagging
approach. Protective equipment has been placed in drawers within wheeled
carts to facilitate ease in accessibility and storage. Upon a trauma patient’s
arrival to the trauma bay, video documentation of the resuscitation is
activated via a button located within the trauma bay.
The attainment of these outcomes could be measured subjectively by staff
members and objectively by evaluating the times from patient’s arrival to the
emergency department to the patient’s final disposition before and after
implementation of role-tagging.
References:
Implementation:
Gowns are pre-sorted on the basis of the allotment for each specific role and packaged into
’Level 1’ packs in order to facilitate timely distribution by the ED Nursing Clinical Leader in
the event of a Level 1 trauma. The ED Clinical leader is responsible for the distribution of the
gowns in addition to ensuring appropriate staffing level and resources within the trauma bay.
1. Sarvecic, A., Palen, L., & Burd, R. (2011) Proceedings of the ACM 2011
Conference on Computer Supported Cooperative Work: Coordinating TimeCritical Work with Role-Tagging. March 19-23, 2011, Hangzhou, China.
2. Sarcevic, A., Marsic, I., Waterhouse, L., Stockwell, D., & Burd, R. (2011).
Leadership structures in emergency care settings: A study of two trauma
centers. Journal of Medical Informatics, 80:227-238.
3. American College of Surgeons. Advanced Trauma Life Support®
(ATLS®), 8th Edition, Chicago, IL, 2008.