Analyzing the Effectiveness of a Pre-Arrival Time-Out in Pediatric Trauma Resuscitations

Abstract

Background: Time-out checklists are commonplace throughout procedural specialties and have been associated with improved care and decreased errors. The WHO has recommended a checklist for trauma care, particularly focused on the trauma resuscitation, to decrease missed injuries and facilitate an efficient resuscitation. However, this checklist does not address pre-arrival preparations that might facilitate a shared mental model for an upcoming resuscitation. The goal of this study was to draft a pre-arrival time-out at Riley Hospital for Children (RHC), emphasizing provider role introductions, patient details, potential care needs upon patient arrival, and patient disposition. 

Methods: Pre-arrival preparation for trauma resuscitations were retrospectively reviewed using trauma video review. All resuscitations took place in one of four trauma bays at the RHC Emergency Department. Recordings captured Level 1 trauma activations. The recordings were abstracted for factors which researchers felt would facilitate strong team dynamics and allow for creation of a shared mental model. A REDCap database was created to capture the deidentified data.   

Results: Twenty-four resuscitations were available for analysis, time-outs occurred in 29.2% (7/24). Time-out attendance was 13.9 (±2.0) personnel. The average length of time-outs was 59.6 (±19.4) seconds and the average time between the end of the time-out and patient arrival was 4 minutes 53.7 seconds (± 3 minutes 37.0 seconds). Introductions were fully completed in 16.7% (4/24) of recordings and in 57.1% (4/7) of occurrences with a time-out performed. A clear team leader was identified in 29.2% (7/24) of resuscitations. Pre-arrival discussions about the case occurred in 83.3% (20/24) of recordings. A stated need for an item (equipment/medication) occurred in 50.0% (12/24) of recorded pre-hospital discussions. 

Conclusion and Potential Impact: The rates of time-outs, introductions, stating patient details, and stating equipment needs before patient arrival were low in many cases. A formalized pre-arrival time-out discussion prior to pediatric trauma resuscitations could be effective in increasing these rates.