PEDIATRIC TRAUMA RESUSCITATIONS Rachel Webman, MD 1 , Jennifer - - PowerPoint PPT Presentation

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Nov 01, 2023 264 likes •489 views

CLASSIFICATION AND RESPONSE TO PROCESS ERRORS OCCURING DURING PEDIATRIC TRAUMA RESUSCITATIONS Rachel Webman, MD 1 , Jennifer Fritzeen 1 , JaeWonYang 1 , Grace Lee 2 , Paul C. Mullan, MD, MPH 3 ,Fiasal G. Qureshi, MD 4 , Sarah H Parker, PhD 5 ,

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CLASSIFICATION AND RESPONSE TO PROCESS ERRORS OCCURING DURING PEDIATRIC TRAUMA RESUSCITATIONS

Rachel Webman, MD1, Jennifer Fritzeen1, JaeWonYang1, Grace Lee2, Paul C. Mullan, MD, MPH3,Fiasal G. Qureshi, MD4, Sarah H Parker, PhD5, Aleksandra Sarcevic PhD6, Ivan Marsic, PhD7, Randall S. Burd, MD, PhD1

1Division of Trauma and Burns, Children’s National Medical Center, Washington, DC 3Division of Emergency Medicine and Trauma Services, Children’s National Medical Center, Washington, DC, 4Division of General and Thoracic Surgery, Children’s National Medical Center, Washington, DC 5National Center for Human Factors in Healthcare, Medstar Institute for Innovation, Washington, DC 6College of Computing and Informatics, Drexel University, Philadelphia, PA 7Department of Electrical and Computer Engineering, Rutgers University, Piscataway. NJ

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ADVERSE EVENT ERROR ERROR

Mitigation Patient condition Luck

NO HARM

RARE FREQUENT

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Objectives Identify and classify errors occurring during trauma resuscitations Evaluate error patterns and team response to errors

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August 2014 Dataset

50 cases 46 cases 30 cases Lack of consent 4 cases Poor quality/erasure 16 cases

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Video Review

Process deviations Process errors Error Class

Selection
Commission
Omission

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Error Classification

Non-routine event Process deviation Innovation/ acceptable variation Process error (potential harm) High risk for potential harm Low risk for potential harm No team response Team response

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Error Classification

Non-routine event Process deviation Innovation/ acceptable variation Process error (potential harm) High risk for potential harm Low risk for potential harm No team response Team response

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Error Classification

Process error (potential harm) Selection Omission Commission

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Data Analysis χ2 test for comparison of response between error categories Pearson’s correlation coefficient used to assess error association with process deviations

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Results Summary Statistics

All activations (n=30) Age, years (mean ± SD) 8.7 ± 0.9 Male (%) 86.7% Penetrating mechanism (%) 3.3% ISS>15 6.7% Activation level Stat 60.0% Transfer 40.0% No pre-notification 10.0% Weekend event 53.3% Daytime event (7 AM-7 PM) 46.7% Adverse events 0%

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Results Summary Statistics

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Results Error Classification

Error type # of occurrences (% of total) Average # per resuscitation All 250 8.3 Error Class Commission 97 (38.8) 3.2 Selection 95 (38.0) 3.2 Omission 58 (23.2) 1.9 Harm Potential High risk 98 (39.2) 3.3 Low risk 152 (60.8) 5.1

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Results Error Type by Phase

10 20 30 40 50 60

Commission Selection Omission p=0.17 Preparatory Primary survey Secondary Survey Post-resuscitative

Process Error (n)

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Results Team Response

Error type Team Response All (n=250) 121 (48.4%) Error Class Commission (n=86) 46 (53.5) Selection (n=95) 33 (34.7) Omission (n=69) 42 (60.9) Harm Potential High risk (n=98) 34 (35.8) Low risk (n-152) 60 (39.5)

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Results Comparison of Response

53.5% 34.7% 60.9% 42.5% 65.3% 39.1%

0% 20% 40% 60% 80% 100% Commission Selection Omission No Response Response

No response Team response

Commission Selection Omission

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Results Comparison of Response

0% 20% 40% 60% 80% 100%

Commission Selection Omission No Response

No response Team response

Commission Selection Omission

p=0.02 p<0.001

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Results Comparison of Response

0% 20% 40% 60% 80% 100%

Commission Selection Omission No Response

No response Team response

Commission Selection Omission

p=0.36

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Results Comparison of Response

42.1% 46.1% 57.9% 53.9%

0% 20% 40% 60% 80% 100%

High risk Low risk No Response Response

p=0.36

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Results Relationship Between Process Errors and Non-Error Deviations

Correlation coefficient 0.24 p-value 0.20

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Summary Adverse events are not common Errors during trauma resuscitations are common

Trauma teams respond to half of the process errors Trauma team response differs between error classes

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Limitations Single institution Small sample size with few severely injured children Subjective evaluation potentially subject to bias

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Implications Errors not associated with patient morbidity are frequent and should be studied to identify risks of and methods for prevention of adverse outcomes