TY - JOUR
T1 - A human factors subsystems approach to trauma care
AU - Catchpole, Ken
AU - Ley, Eric
AU - Wiegmann, Doug
AU - Blaha, Jennifer
AU - Shouhed, Daniel
AU - Gangi, Alexandra
AU - Blocker, Renaldo
AU - Karl, Richard
AU - Karl, Cathy
AU - Taggart, Bill
AU - Starnes, Benjamin
AU - Gewertz, Bruce
PY - 2014/9/1
Y1 - 2014/9/1
N2 - IMPORTANCE A physician-centered approach to systems design is fundamental to ameliorating the causes of many errors, inefficiencies, and reliability problems.OBJECTIVE To use human factors engineering to redesign the trauma process based on previously identified impediments to care related to coordination problems, communication failures, and equipment issues.DESIGN, SETTING, AND PARTICIPANTS This study used an interrupted time series design to collect historically controlled data via prospective direct observation by trained observers. We studied patients from a level I trauma center from August 1 through October 31, 2011, and August 1 through October 31, 2012.INTERVENTIONS A range of potential solutions based on previous observations, trauma team engagement, and iterative cycles identified the most promising subsystem interventions (headsets, equipment storage, medication packs, whiteboard, prebriefing, and teamwork training). Five of the 6 subsystem interventions were successfully deployed. Communication headsets were found to be unsuitable in simulation.MAIN OUTCOMES AND MEASURES The primary outcome measurewas flowdisruptions, with treatment time and length of stay as secondary outcome measures.RESULTS A total of 86 patients were observed before the intervention and 120 after the intervention. Flow disruptions increased if the patient had undergone computed tomography (CT) (F1200= 20.0, P <.001) and had been to the operating room (F1200= 63.1, P <.001), with an interaction among the intervention, trauma level, and CT (F1200= 6.50, P =.01). For total treatment time, there was an effect of the intervention (F1200= 21.7, P <.001), whether the patient had undergone CT (F1200= 43.0, P <.001), and whether the patient had been to the operating room (F1200= 85.8, P <.001), with an interaction among the intervention, trauma level, and CT (F1200= 15.1, P <.001), reflecting a 20-to 30-minute reduction in time in the emergency department. Length of stay was reduced significantly for patients with major mortality risk (P =.01) from a median of 8 to 5 days.CONCLUSIONS AND RELEVANCE Deployment of complex subsystem interventions based on detailed human factors engineering and a systems analysis of the provision of trauma care resulted in reduced flow disruptions, treatment time, and length of stay.
AB - IMPORTANCE A physician-centered approach to systems design is fundamental to ameliorating the causes of many errors, inefficiencies, and reliability problems.OBJECTIVE To use human factors engineering to redesign the trauma process based on previously identified impediments to care related to coordination problems, communication failures, and equipment issues.DESIGN, SETTING, AND PARTICIPANTS This study used an interrupted time series design to collect historically controlled data via prospective direct observation by trained observers. We studied patients from a level I trauma center from August 1 through October 31, 2011, and August 1 through October 31, 2012.INTERVENTIONS A range of potential solutions based on previous observations, trauma team engagement, and iterative cycles identified the most promising subsystem interventions (headsets, equipment storage, medication packs, whiteboard, prebriefing, and teamwork training). Five of the 6 subsystem interventions were successfully deployed. Communication headsets were found to be unsuitable in simulation.MAIN OUTCOMES AND MEASURES The primary outcome measurewas flowdisruptions, with treatment time and length of stay as secondary outcome measures.RESULTS A total of 86 patients were observed before the intervention and 120 after the intervention. Flow disruptions increased if the patient had undergone computed tomography (CT) (F1200= 20.0, P <.001) and had been to the operating room (F1200= 63.1, P <.001), with an interaction among the intervention, trauma level, and CT (F1200= 6.50, P =.01). For total treatment time, there was an effect of the intervention (F1200= 21.7, P <.001), whether the patient had undergone CT (F1200= 43.0, P <.001), and whether the patient had been to the operating room (F1200= 85.8, P <.001), with an interaction among the intervention, trauma level, and CT (F1200= 15.1, P <.001), reflecting a 20-to 30-minute reduction in time in the emergency department. Length of stay was reduced significantly for patients with major mortality risk (P =.01) from a median of 8 to 5 days.CONCLUSIONS AND RELEVANCE Deployment of complex subsystem interventions based on detailed human factors engineering and a systems analysis of the provision of trauma care resulted in reduced flow disruptions, treatment time, and length of stay.
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U2 - 10.1001/jamasurg.2014.1208
DO - 10.1001/jamasurg.2014.1208
M3 - Article
C2 - 25103360
AN - SCOPUS:84907210932
SN - 2168-6254
VL - 149
SP - 962
EP - 968
JO - JAMA surgery
JF - JAMA surgery
IS - 9
ER -