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2017 ; 25
(1
): 20
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Development of the major trauma case review tool
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Curtis K
; Mitchell R
; McCarthy A
; Wilson K
; Van C
; Kennedy B
; Tall G
; Holland A
; Foster K
; Dickinson S
; Stelfox HT
Scand J Trauma Resusc Emerg Med
2017[Feb]; 25
(1
): 20
PMID28241880
show ga
BACKGROUND: As many as half of all patients with major traumatic injuries do not
receive the recommended care, with variance in preventable mortality reported
across the globe. This variance highlights the need for a comprehensive process
for monitoring and reviewing patient care, central to which is a consistent
peer-review process that includes trauma system safety and human factors. There
is no published, evidence-informed standardised tool that considers these factors
for use in adult or paediatric trauma case peer-review. The aim of this research
was to develop and validate a trauma case review tool to facilitate clinical
review of paediatric trauma patient care in extracting information to facilitate
monitoring, inform change and enable loop closure. METHODS: Development of the
trauma case review tool was multi-faceted, beginning with a review of the trauma
audit tool literature. Data were extracted from the literature to inform
iterative tool development using a consensus approach. Inter-rater agreement was
assessed for both the pilot and finalised versions of the tool. RESULTS: The
final trauma case review tool contained ten sections, including patient factors
(such as pre-existing conditions), presenting problem, a timeline of events,
factors contributing to the care delivery problem (including equipment, work
environment, staff action, organizational factors), positive aspects of care and
the outcome of panel discussion. After refinement, the inter-rater reliability of
the human factors and outcome components of the tool improved with an average 86%
agreement between raters. DISCUSSION: This research developed an
evidence-informed tool for use in paediatric trauma case review that considers
both system safety and human factors to facilitate clinical review of trauma
patient care. CONCLUSIONS: This tool can be used to identify opportunities for
improvement in trauma care and guide quality assurance activities. Validation is
required in the adult population.
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