I’ve spent the last few days showing you the major problems inherent in using an electronic trauma flow sheet (eTFS). It boils down to Garbage In / Garbage Out and time. It costs a lot of money, and weakens the otherwise strong trauma performance improvement process.
Here’s the real bottom line:
” A hospital using an electronic trauma flow sheet is paying a lot of money for a product that forces them to pay even more money for people to essentially transcribe inaccurate data back onto a paper trauma flow sheet.”
So what can be done about it? That depends on whether the eTFS has already been implemented. Today, I’ll discuss what to do if it’s still in the planning stages.
You’ve just heard that your hospital is considering switching to an eTFS. Here’s what you should do:
- Warn everyone you can, loudly! Use all of the ammunition you’ve read about here. Talk to your administrative contacts. Ultimately, your CEO needs to hear the concerns.
- Visit another hospital with similar trauma volumes using the same eTFS. Don’t just call them up and ask how it’s going. Actually go and visit, and watch during an actual trauma activation. How is the scribe doing? Can they keep up? Is there a “cheat sheet?” Then talk to the people who abstract the eTFS data. Ask how long it takes compared to the old days of paper.
- Consider a test implementation, and have two scribes, one using the eTFS and one using a paper sheet. After each trauma activation, objectively compare scribe performance, accuracy, and completeness. The eTFS cannot be allowed until they are equivalent (which I have never seen).
- During the test implementation, have two abstractors analyze the data, one using the eTFS and one using the paper sheet. How long does it take to find all pertinent demographics, sign-in times, primary survey, secondary survey/exam, procedures, vital signs flow, fluids & IVs, I&O? Was the patient hypotensive? What activities occurred during those times: procedures, drugs, CT scan? The eTFS cannot be allowed until they are equivalent (which I have also never seen).
- Continue to work with your hospital administration, showing them this data. Hopefully they will see the light and abandon this “great idea.”
But what if they don’t? Or what if you’ve walked into a program that is already using it? I’ll discuss that tomorrow.