Table 3

Collaboratively developed interventions

InterventionTeams involved
Trauma team expectations of conduct
Registrars and residents providing trauma coverage currently receive minimal introduction as to the expectations of that role. The trauma service is creating a document outlining high expectations around behaviour, communication and conduct involved in trauma care to be circulated at the beginning of every term
Trauma service, distribution to all others
OneTeam practice
Our work showed that team briefings are essential for laying a foundation for relational coordination for a single case. To improve, our emergency teams have started a mental rehearsal each morning
ED
Trauma leader feedback
Emergency trauma team leaders now have the opportunity to receive structured feedback on their performance from fellow consultants, registrars, nurses or other trauma team personnel
ED primarily
To CT ‘Fast and Safe’ simulations
Radiographers and emergency teams are working collaboratively to develop and evaluate a spiral simulation curriculum to improve the transfer of patients to and from the CT scanner
ED, medical imaging
Event management
Trauma service is designing and implementing a number of interventions to improve crowd control
Trauma, ED
Radiology ‘Primary Survey’
In an effort to improve efficiency and facilitate decision-making, the ED team leaders and radiology registrars are encouraged to engage in the radiology ‘primary survey’ where the radiologist reviews the CT scans while the patient is on the table to identify significant injuries and determine if further imaging is needed before patient leaves the CT scanner
ED, medical imaging, trauma
Combined radiographer/radiologist and ED teaching
Deliberate inclusion of radiographers as appropriate in monthly ED resuscitation/trauma teaching is now standard
Medical imaging
Maximising radiographer presence at alerts and responds
Medical imaging is critical to the early phases of trauma management and is an adjunct to the primary survey. The radiographer team are working to improve attendance at traumas through improving communication channels and attending team briefings
Medical imaging
Feedback with high acuity response paramedics
Paramedics are responsible for the initial assessment of major trauma patients and often provide initial life-saving interventions. As a group, they undergo a rigorous audit process but often do not have all of the information they need to evaluate their work. The trauma service is now working with the paramedic service to provide access to imaging and provide early feedback related to their assessments and interventions
Trauma, pre-hospital
Red blanket handover simulation
Paramedics rarely enter the operating theatre. When they do it is in the context of a ‘Red-Blanket’ (direct to theatre, critically bleeding trauma patient). Anaesthetics and paramedics have designed and implemented handover simulations to improve relationships and performance in this rare, high-stakes encounter
Anaesthetics, pre-hospital, trauma
Damage control workshop
Anaesthetics, trauma and surgery designing and delivering a 1-day interactive workshop with a focus on damage control resuscitation and damage control surgery
Anaesthetics, trauma, surgery
Trauma operating theatre simulations
Anaesthetics, surgery and trauma are working with the simulation service to design and deliver trauma-related simulation exercises on a quarterly basis
Trauma, anaesthetics, surgery
ED to operating theatre to ICU handover
A critical moment of transition is the transfer of patients from theatre to ICU. The most unwell patients may not yet have had trauma imaging or completion of a primary survey. Through a number of educational, simulation and systems interventions anaesthetics, surgery, ICU and ED will explore ways to optimise transitions in trauma leadership
Trauma, ICU, ED, anaesthetics, surgery
Trauma stand downs
Trauma team leaders to initiate a trauma ‘stand down’ after the radiology primary survey at which time all teams must discuss and document plans for the patient before decanting. To be incorporated in ‘Trauma Team Expectations of Conduct’ and ongoing simulation exercises
ED, trauma
Video feed to operating theatre
For critically unwell patients requiring theatre, a video feed from trauma bays will be available in the anaesthetist, scrub nurse and surgeon in the emergency operating theatre so that the team can be directly aware of injuries, vascular access and progress towards theatre
ED, surgery, anaesthetics
Trauma simulation training
Continue monthly simulation training but with updated focus on fostering relational foundations of work across interfaces by through scenario creation and debriefing focus
All
Trauma operating theatre RC
To build on this work, the anaesthetics and surgery groups are interested in focusing on relational interfaces once the patients reach the operating theatre. They intend to undergo a similar study to the own performed but with focus on the patient who is in the operating room, not the trauma bay. This will include some new groups (blood bank, operating theatre staff, vascular surgery, cardiothoracic surgery) with some overlap from the current study (surgery, ICU, anaesthetics, trauma)
Anaesthetics, surgery, ICU, trauma
  • ED, emergency; ICU, intensive care; RC, relational co-ordination.