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Abstract
Background Paediatric traumas have been described as high-stake, low occurrence emergencies and are a leading cause of morbidity and mortality worldwide. Delivering appropriate care is imperative and relies on interdisciplinary teamwork.
Assessment of issue Informal interviews revealed that interruptions from various team members, as they enter the trauma bay, to the trauma team leader (TTL) was felt to contribute to poor communication and teamwork. Digital monitors in the trauma bay at our institution were therefore introduced to display information using the ‘ATMIST (Age, Time, Mechanism, Injury, Signs, Treatment)’ mnemonic. Unfortunately, uptake had been poor, being used in only half of the cases.
Strategy for improvement We identified factors (figure 1) contributing to the inconsistent use of the ATMIST tool and then implemented various strategies to improve use of the tool such as we increased awareness by email communication and added the ATMIST tool as pre-arrival checkbox to the trauma intake form. Improvement of interventions were studied through structured observation of traumas. The outcome measure was defined as the proportion of total trauma activations with ATMIST tool partially or fully completed. Additional measures included number of interruptions to TTL (clinical measure), number of incorrectly entered items (balancing measure), and TTL satisfaction (qualitative measure). There was an increased use of the ATMIST tool from 50% to 66% in a 2 month period following all interventions. Interruptions to the TTL were observed less frequently and there was no increase in incorrect items displayed.
Lessons learnt Continuous QI methodology help identify obstacles and strategies to improve overall care. More trauma observations and further PDSA cycles, now that strategies have been implemented, are required in order to determine whether the tool continues to be used, reduces TTL interruptions, improves overall communication and teamwork.