Failure mode effects analysis of re-triage of injured patients to receiving high-level Illinois trauma centers

Authors

John D. Slocum, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Jane L. Holl, Department of Neurology, Pritzker School of Medicine, University of Chicago, Chicago, IL.
William M. Brigode, Department of Trauma and Burn, John H. Stroger Hospital of Cook County, Chicago, IL.
Mary Beth Voights, Department of Surgery, Carle Foundation Hospital, Urbana, IL.
Michael J. Anstadt, Department of Surgery, Stritch School of Medicine, Loyola University, Chicago, IL.
Marion C. Henry, Department of Surgery, Comer Children's Hospital, Pritzker School of Medicine, University of Chicago, Chicago IL.
Justin Mis, Department of Trauma and Burn, John H. Stroger Hospital of Cook County, Chicago, IL.
Richard J. Fantus, Advocate Health - MidwestFollow
Timothy P. Plackett, Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago IL.
Eddie J. Markul, Advocate Health - MidwestFollow
Grace H. Chang, Department of Surgery, Mount Sinai Hospital, Chicago, IL.
Michael B. Shapiro, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Nicole Siparsky, Department of Surgery, Rush University Medical College, Chicago, IL.
Anne M. Stey, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.

Recommended Citation

Slocum JD, Holl JL, Brigode WM, et al. Failure Mode Effects Analysis of Re-triage of Injured Patients to Receiving High-Level Illinois Trauma Centers. Ann Surg. Published online October 11, 2024. doi:10.1097/SLA.0000000000006561

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Objective:This study identified failures in emergency inter-hospital transfer, or re-triage, at high-level trauma centers receiving severely injured patients.

Summary background data:The re-triage process averages four hours despite the fact timely re-triage within two hours mitigates injury-associated mortality. Non-trauma and low-level trauma centers reported most critical failures were in finding an accepting high-level trauma center. Critical failures at high-level trauma centers have not been assessed.

Methods:This was an observational cross-sectional study at nine high-level adult trauma centers and three high-level pediatric trauma centers. Failure Modes Effects Analysis (FMEA) of the re-triage process was conducted in four phases. Phase 1 purposively sampled trauma coordinators followed by snowball sampling of clinicians, operations, and leadership to ensure representative participation. Phase 2 mapped each re-triage step. Phase 3 identified failures at each step. Phase 4 scored each failure on impact, frequency, and safeguards for detection. Standardized rubrics were used in Phase 4 to rate each failure's impact (I), frequency (F), and safeguard for detection (S) to calculate their Risk Priority Number (RPN) (I x F x S). Failures were rank ordered for criticality.

Results:A total of 64 trauma coordinators, surgeons, emergency medicine physicians, nurses, operations and quality managers across twelve high-level trauma centers participated. There were 178failures identified at adult and pediatric high-level trauma centers. The most critical failures were: Insufficient trained transport staff (RPN=648); Issues transmitting imaging from sending to receiving centers (RPN=400); Incomplete exchange of clinical information(RPN=384).

Conclusions:The most critical failures were limited transportation and incomplete exchange of clinical, radiological and arrival timing information. Further investigation of these failures that includes several regions is needed to determine the reproducibility of these findings.

Document Type

Article

PubMed ID

39471084