Yesterday, I discussed a paper that tried to show that the “delay to OR” trauma performance improvement (PI) filter was not cost effective. As I mentioned, I’m dubious that the outcomes and information reviewed could realistically demonstrate this.
Today, I’m going to list the parts of the system that this PI filter helps to monitor:
- Was the patient appropriately triaged as a trauma activation?
- Was the trauma surgeon called / involved in a timely manner?
- Was an appropriate physical exam carried out?
- If needed, was the CT scanner accessible?
- Did the surgeon make an appropriate clinical decision?
- If needed, did the backup trauma surgeon arrive in a timely manner?
- Were there any transport delays to the OR?
- Was an OR room promptly available?
- Did the OR backup team arrive within the required time, if needed?
- Were anesthesia services promptly available?
- If a failure of nonoperative management occurred:
- Was the practice guideline followed?
- Were repeat vitals and physical exam performed and documented?
- Did any of the other issues listed above occur?
And you may be able to think of even more!
Bottom line: As you can see, this seemingly innocuous filter tests many components within the trauma center. And even if one particular patient who triggers the “delay to OR” filter is lucky enough to escape unharmed, many of the areas listed above can harm other patients who may not trigger it. Actively looking for these issues and fixing them makes your entire trauma program better!