Trauma Team Performance Indicators
	Date: 18.03.97 13:15 From: Tim Coats [t.coats@dial.pipex.com] Hi, We are at present looking at how we should audit the performance of our trauma team, facilities for video recording are in place (although I am aware of the legal difficulties that may surround this). We would be very interested to hear how you audit this phase, and the quality indicators that you have used. What makes a good trauma team? How do you train Team Leaders? Also, how do you feed this information back to the clinicians in a way that leads to improvement in quality? Tim Coats Mr. T. J. Coats FRCS. Senior Lecturer in Accident and Emergency / Pre-Hospital Care. Royal London Hospital.
	Date: 19.03.97 13:16 From: Eric Frykberg MD I'm not sure videos help in this assessment at all--it may serve as a teaching tool for criticisms of performance, but not for assessing quality. Documenting response times and time spent in the trauma resuscitation area, as well as preventable death evaluation, are examples of quality indicators we use. Eric Frykberg, M.D. Jacksonville, Fl
	Date: 19.03.97 15:36 From: "Dr. Ed Walker" Tim - Our hospital is part of the Yorkshire MTOS (Major Trauma Outcome Study) group. While this does not specifically look at trauma teams, or their leaders (its more about TRISS methodology and league tables - supposedly anonymous, but you can usually guess), they may have ideas about auditing teamwork. Videoing resus. room scenes is something I am not a big fan of. Unlike some members of the profession, I don't perform well in front of a camera, and I bet even '999' give you the option of asking them to stop filming while you have a third go at that drip.
	Date: 19.03.97 22:29 From: "John A. Aucar, M.D." There may be something to be said for customizing the indicators and the mechanism for feedback evaluation of trauma resuscitation. Besides avoiding the distasteful notion that what I do is what you should do, developing your own program will more efficiently address your own areas of weakness. The alternative is to exert a certain amount of effort to identify what you already do right, which is a less effective way to use the system. We, until recently, reviewed tapes with our residents both individually and in a quality assurance conference. The approach I recommend is to review some resuscitations, consider what parts you are happy with and what parts seem lacking. Focus on the areas that seem deficient and follow that until it improves. Notice weather you can always readily identify who the trauma team leader is. Often the designated leader is not the one who is taking charge. How occupied is the leader in doing jobs that should be delegated? How organized is the process of delegating responsibilities. How many people are in the room who are not actively contributing. I find these issues more relevant than timing how long before someone listens to the chest (30 seconds vs 1.5 minutes, if it's 20 minutes, maybe you had better look at it). Most who use this method of self evaluation and review find it very helpful, even if a bit painful. Good luck. JAA -- John A. Aucar, M.D.,F.A.C.S. Dept. of Surgery One Baylor Plaza Houston, TX 77030 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Assistant Professor, Surgery, Baylor College of Medicine Ben Taub Gen. Hospital; http://www.bcm.tmc.edu/surgery/ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
	Date: 20.03.97 16:26 From: John Trickett [JTRICKETT@ogh.on.ca] Tim, We have also been faced with this one, and on reveiwing the literature there was a limited amount of information on "team performance". We took a consensus on a variety of indicators relevent to the resucitation phase, and tried to apply a "reasonable" quantifier. This was then developed into a "tool" which I have appended for your review. It may be found that some of the time lines are not approriate for other settings. (Eg our penetrating rate is 5%) The tool was used over a two monthe period and we were quite pleased with its performance, as an indicator of areas doing very well, and those which needed improving. If looking at using this tool, it is vital to have "buy in" from those involved in the evaluation process. There are a few items not included on the tool which we use as quality indicators, but we have access to them through our regular data base. (Eg Emergency dept length of stay, frequency of charting, etc) The appended tool was published, along with another similar evaluation tool from Salem Oregan, in The International Journal of Trauma Nursing, Vo 2, (4) October 1996. I look forward to comments on the tool and its applicability elsewhere. Good luck John Trickett RN Trauma Coordinator Ottawa General Hospital 501 Smyth Ottawa Canada
	Date: 20.03.97 17:27 From: Mr M Akmal [plas-rlh@plas-rlh.demon.co.uk] Hi Tim, Interesting question. Having participated in the trauma team myself. I think there is no doubt that the team functions best with a clear, precise and well spoken team leader. As far as training team leaders goes, how about the traditional practices of surgery in which they are taken through some cases with an experienced trauma team leader. Initially only watching and then being allowed to do more. Trauma interspecialty meetings and regular case presentations are an excellent way to teach and learn. Auditing performance is very difficult unless you have specific parameters that you would like to look at ie cost, survival, time delays etc. I agree it is very difficult to audit quality of the trauma team itself, more so when you try to look at it as a system isolated from the rest of the hospital ecosystem. Best regards Mo Mr M Akmal BSc FRCS Royal London Hospital
	Date: 22.03.97 00:09 From: dannymac@netcentral.co.uk (Mr D.F. McGeehan) Hi Tim Enjoyed your talk in London on Thursday. While I worked in Stoke Professor Mike Smith ran a computer program in graphic tablate form that plotted trauma resuscitation. It gave a graphic readout. The learned Professor has now moved to London but if you were interested I could give you his address and I am sure he would be happy to demonstrate it for you. He is a man years ahead of his time Danny Mr D.F. McGeehan MB FRCS FFAEM Consultant in A & E Medicine Stafford District General Hospital Stafford