Trauma Resuscitation Room Organization Using 5S Methodology: A Quality Improvement Initiative.

BACKGROUND: Trauma centers are required to have immediate availability of resources to stabilize traumatic injuries. However, maintaining trauma room organization can be challenging in the fast turnaround environment of trauma care. Implementation of 5S methodology has shown success in standardizing processes to maintain organized, efficient workspaces. OBJECTIVE: The purpose of this study was to assess the implementation of 5S methodology on trauma resuscitation room organization, efficiency, and cost-effectiveness. METHODS: This quality improvement pre- and postintervention study assessed the impact of 5S methodology on trauma resuscitation room organization. A 20-question survey was developed and administered to emergency department technicians before and after a multiphase intervention that included strategies for room reorganization, improved signage, creation of workstations, education, and implementation of a log sheet system. A final cost analysis was evaluated upon completion. RESULTS: Emergency department technicians completed n = 26 presurveys and n = 19 postsurveys. Room organization improved from preintervention 31% to postintervention 89%. Restocking with a checklist improved from 46% preintervention to 63% postintervention. A cost analysis summary identified 130 overstocked items equaling a total cost savings of $4,026.82. CONCLUSION: The 5S methodology improved trauma bay organization by sorting, organizing, standardizing, labeling, and color coding resuscitation supplies based on the ABCDE (airway, breathing, circulation, disability, and exposure) of the primary survey. Additional strategies included improved signage, workspace reorganization, staff education, and checklist restocking accountability. The 5S implementation resulted in significant cost savings.

Impact of the COVID-19 pandemic on trauma activations at a pediatric level 1 trauma center in New York.

BACKGROUND: The disruptive effects on society and medical systems due to the coronavirus disease 2019 (COVID-19) pandemic are substantial and far-reaching. The effect of the pandemic on the quantity and quality of pediatric traumas is unclear and has a direct bearing on how scarce hospital resources should be allocated in a pandemic situation. METHODS: A retrospective review of the trauma registry was performed for trauma activations in the years 2018 through 2020 during the months of March, April, and May. Demographic and injury specific datapoints were compared across calendar years. RESULTS: There were 111, 100, and 52 trauma activations during the study interval in 2018, 2019, and 2020, respectively. There were fewer highest severity level activations in 2020 compared to 2018 and 2019 (1 vs 5 and 9; p < 0.01). The median Injury Severity Score was 5 in 2020 compared to 4 in both 2018 and 2019 (p < 0.01). More patients went directly to the operating room in 2020 compared to prior years (21.2% vs 8% and 6.1%; p < 0.01). There were fewer discharges from the emergency department (ED) (12.1% vs 36.6% and 32.7%). No increase in the number of child abuse reports and investigations was noted. There was no difference in the proportion of blunt versus penetrating trauma between years (p = 0.57). No pedestrians were struck by automobiles in 2020 compared to 12 and 14 in 2018 and 2019. However, there were a greater proportion of injuries from falls during 2020 compared to prior years. CONCLUSIONS: There were fewer trauma activations during the peak of the COVID pandemic compared to prior years. Due to the decrease in trauma volume during the peak of the pandemic, hospital resources could potentially be reallocated toward areas of greater need. LEVEL OF EVIDENCE: IV; Retrospective cohort study using historical controls.

Decreased Pediatric Trauma Length of Stay and Improved Disposition With Implementation of Lewin's Change Model.

Although often cared for nonoperatively, trauma is a surgical disease managed by surgical services in a multidisciplinary manner. The American College of Surgeons Committee on Trauma (ACS COT) emphasizes this as part of the ACS COT verification process and expects nonsurgical service admission rate of less than 10%. In this project, we developed a collaborative care model captained by surgical services with medical service consultation to achieve this goal for optimal care of injured patients. The project was conducted at a freestanding pediatric trauma center undergoing verification as a Level 1 ACS COT pediatric trauma center. The trauma registry was utilized to obtain nonsurgical service admission rate from January 2011 to June 2015. Lewin's 3-Step Model was utilized to guide change. Adherence to the new ACS standards was continually tracked and fallouts were addressed on an individual basis. Overall compliance was reported routinely through trauma and hospital quality programs. Individual successes and accomplishments were recognized and reinforced. At the inception of the project, nonsurgical admission rate was 30%. Implementation of Lewin's 3-Step Model nonsurgical admission rate decreased to 3%, representing a reduction of 27%. In addition, a 21% reduction in hospital length of stay, 3.78-3 days, was demonstrated with no change in 30-day readmission rate. Lewin's change model facilitated culture change to achieve ACS COT standards and reduced nonsurgical admissions to less than 10%. Reduction in hospital length of stay supports an improvement in the efficiency of care when directed by the pediatric trauma surgery team.