Development of the major trauma case review tool

Kate Curtis; Rebecca Mitchell; Amy McCarthy; Kellie Wilson; Connie Van; Belinda Kennedy; Gary Tall; Andrew Holland; Kim Foster; Stuart Dickinson; Henry T Stelfox

doi:10.1186/s13049-017-0353-5

Development of the major trauma case review tool

Scand J Trauma Resusc Emerg Med. 2017 Feb 28;25(1):20. doi: 10.1186/s13049-017-0353-5.

Authors

Kate Curtis^{1

2}, Rebecca Mitchell³, Amy McCarthy¹, Kellie Wilson⁴, Connie Van⁵, Belinda Kennedy¹, Gary Tall⁶, Andrew Holland⁷, Kim Foster^{1

8}, Stuart Dickinson⁹, Henry T Stelfox¹⁰

Affiliations

¹ Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia.
² St George Clinical School, Faculty of Medicine, University of New South Wales, Gray St, Kogarah, NSW, Australia.
³ Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
⁴ NSW Institute of Trauma and Injury Management, Level 4, Sage Building, 67 Albert Avenue, Chatswood, NSW, Australia.
⁵ Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia. connie.van@sydney.edu.au.
⁶ NSW Ambulance, Level 2, Sydney Ambulance Centre, Garden St Eveleigh, NSW, 2015, Australia.
⁷ Sydney Medical School, The University of Sydney and The Children's Hospital at Westmead, Sydney, NSW, Australia.
⁸ NorthWestern Mental Health & School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Level 1 North, City Campus, The Royal Melbourne Hospital Grattan Street, Parkville, VIC, 3050, Australia.
⁹ Human Risk Solutions, Victoria, Australia.
¹⁰ Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.

Abstract

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.

Keywords: Adverse event; Emergency; Human factors; Injury; Morbidity; Mortality; Organizational factors; Peer review; Quality; Safety.

MeSH terms

Consensus
Humans
Medical Audit / methods*
Patient Safety
Peer Review
Quality of Health Care
Wounds and Injuries* / therapy