Today, I’ll kick off my series on use of the electronic trauma flow sheet (eTFS) with a list of the typical reasons used to justify it. 

Typically, hospital administrators pressure trauma programs to adopt an eTFS at some point after implementation of an electronic health record (EHR). For the most part, they give two reasons:

1. We need to go paperless! The assumption is that all of the rest of the charting will be electronic, so the trauma flow sheet should be moved to this format as well.
   The reality is that there will always be some good, old-fashioned paper parts to the patient’s chart. Every hospital ward has a little cubby with some old-timey three ring binders for putting the scraps of paper that accumulate. These may be records from an outside referring hospital, a pre-hospital run sheet, blood bank tags from units of blood products, and other stuff. What typically happens to it? It gets scanned into the chart at some point. 
   So there is no reason that a paper trauma flow sheet can’t be scanned as well. The key move is that it should be scanned early so that it is available in the EHR as soon as it is complete.
2. We need to see patient flow, vitals, meds, etc from the time they hit the door. We don’t want to miss the activity that occurs in the trauma bay, right?
   The care typically received in the trauma bay is what I would consider a singularity. It is like nothing else in the hospital stay in terms of pace, intensity, and level of activity. Being able to trend medication or blood administration from arrival through discharge is not that important. Vital signs during resuscitation may be nothing like those of the rest of the hospital stay. It’s just not that helpful to be able to connect that phase of care with the rest of it.
   But having said that, it may be helpful to be able to see all of the medications given during a hospital stay. Ideally, someone should go back and reconcile the medications after the fact. A pharmacist, perhaps?

Neither of these excuses really hold any water, so don’t get talked into trying out an eTFS because of them.

Tomorrow, I’ll write about why the eTFS doesn’t work during the trauma resuscitation phase of care.