Impact of video recordings review with structured debriefings on trauma team performance: a prospective observational cohort study.

PURPOSE: To determine the impact of structured debriefings (SD) with audio/video review of trauma patients' resuscitation events on trauma team (TT) technical and non-technical skills. METHODS: Single-center prospective observational cohort study. The study included all emergency department patients aged 18 years or older who received resuscitation from the TT. Virtual meeting was held with the TT using SD to review one trauma patient resuscitation video. Technical skills improvement was based on adherence to the ATLS protocol and non-technical skills based on T-NOTECHS scale. RESULTS: There was statistically significant improvement in adherence to the ATLS protocol: 73% [55-82%] vs 91% [82-100%] (p < 0.001); and improvement in T-NOTECHS scale: 12 [10-14] vs 16 [14-19] points (p < 0.001). CONCLUSION: In this study, we found that structured debriefings with review of patients' resuscitation video recordings can have a significant positive impact on trauma team performance in the emergency department in both technical and non-technical skills.

Impact of the COVID-19 lockdown on trauma team activations in a single major Lithuanian trauma center: A retrospective single-center study.

Background: As a result of the coronavirus disease 2019 (COVID-19) pandemic and national quarantine, different levels of social and movement restrictions, and stay-at-home requests, trauma trends have changed. The aim of the present study was to determine the impact of lockdown on patients treated by the trauma team (TT) at a single major Lithuanian trauma center during the COVID-19 pandemic. Methods: This is a retrospective, descriptive study of adult (≥18 years old) trauma patients (for whom the TT was activated). Consequently, we analyzed the national lockdown periods from 16 March to 15 May 2020 and from 16 December 2020 to 28 February 2021, compared with the corresponding period of the previous year. Results: There was a 10% reduction in TT activations during the national lockdown period. No significant differences were noted in patient demographics. In the COVID-19 cohort, patients had higher Injury Severity Score (14 [IQR 6-21] vs. 9 [IQR 3-18], P = 0.025) and longer time to computed tomography scan (33 [IQR 25-43] vs. 23 [IQR 20-31] min, P < 0.001). Moreover, in the COVID-19 cohort, three times more patients were transferred from the emergency department (ED) straight to the operating room (n = 12 [19%] vs. n = 4 [5.7%], P = 0.018, Cramer's V = 0.21). Conclusion: Patients were more severely injured, and more patients required emergent surgery during the lockdown. In addition, it took longer to transfer patients to the ED and to perform a computed tomography scan.

What happens in the shock room stays in the shock room? A time-based audio/video audit framework for trauma team performance analysis.

INTRODUCTION: A precise tool for analysis of trauma team performance is missing. OBJECTIVES: To create a framework for trauma team performance analysis and feedback. METHODS: An observational study in a level I trauma centre in Lithuania was performed from January 1 2017 to August 31 2017. Audio/video review process was used to evaluate technical and nontechnical performance of the trauma team. RESULTS: In total, 143 trauma team activations were analysed. The mean rate of completion for the primary survey based on Advanced Trauma Life Support principles was 68.5%. Technical steps of patient resuscitation were measured in seconds during first hour of the treatment. The T-NOTECHS scale mean score was 11.99 (SD 2.9). CONCLUSION: During the study period, we were able to measure the time needed for certain steps in trauma patient evaluation and management. Based on this analysis, a performance improvement program will be devised, including the HybridLab medical simulation, audio/video debriefing, and individualised feedback sessions.

How the changes in the system affect trauma care provision: The assessment of and implications for Lithuanian trauma service performance in 2007-2012.

OBJECTIVE: The aim of this study was to identify and assess the effects of changes in the Lithuanian trauma service from 2007 to 2012. We postulate that the implications derived from this study will be of importance to trauma policy planners and makers in Lithuania and throughout other countries of Eastern and Central Europe. MATERIALS AND METHODS: Out of 10,390 trauma admissions to four trauma centers in 2007, 294 patients (2.8%) were randomly selected for the first arm of a representative study sample. Similarly, of 9918 trauma admissions in 2012, 250 (2.5%) were randomly chosen for comparison in the study arm. Only cases with a diagnosis falling into the ICD-10 "S" and "T" codes were included. A survey of whom regarding changes in quality of trauma care from 2007 to 2012 was carried out by emergency medical service (EMS) providers. RESULTS: The Revised Trauma Score (RTS) mean value was 7.45±1.04 for the 2007 year arm; it was 7.53±0.93 for the 2012 year arm (P=0.33). Mean time from the moment of a call from the site of the traumatic event to the patient's arrival at the trauma center did not differ between the arms of the sample: 49.95min in 2007 vs. 51.6min in 2012 (P=0.81). An application of the operational procedures such as a cervical spine protection using a hard collar, oxygen therapy, infusion of intravenous fluids, and pain relief on the trauma scene was more frequent in 2012 than in 2007. Management of trauma patients in the emergency department improved regarding the availability of 24/7 computed tomography scanner facilities and an on-site radiographer. Time to CT-scanning was reduced by 38.8%, and time to decision-making was reduced by 16.5% in 2012. CONCLUSIONS: Changes in operational procedures in the Lithuanian pre-hospital care provision and management of trauma patients in emergency departments of trauma centers improved the efficiency of trauma care delivery over the 2007-2012 period.