Effect of the implementation of a checklist in the prehospital management of a traumatised patient.
Checklist
Educational
Human factor
Prehospital
Trauma management
Journal
The American journal of emergency medicine
ISSN: 1532-8171
Titre abrégé: Am J Emerg Med
Pays: United States
ID NLM: 8309942
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
04
07
2023
revised:
14
07
2023
accepted:
15
07
2023
medline:
25
9
2023
pubmed:
31
7
2023
entrez:
30
7
2023
Statut:
ppublish
Résumé
In October 2021, French acute care societies jointly published cognitive aids to standardise practices and limit cognitive biases to ensure greater safety in management of severe trauma patients. The aim of the study was to evaluate the impact of a checklist on emergency physicians' adherence to the recommendations. This prospective before-and-after study study took place in a French mobile emergency and resuscitation service. All adults trauma patients referred to hospital were included. A checklist on trauma management inspired by the MARCHE acronym was produced. During phase I, the checklist was performed within 24 h after the end of the intervention. During phase II, the checklist was performed during the patient's transport to hospital, thus allowing potentially omitted procedures to be performed initially. The use of the checklist was systematically evaluated using an anonymous questionnaire among doctors and nurses. In phase II, doctors and nurses who did not perform checklist were systematically asked to answer a specific online questionnaire. The primary outcome was the overall omission rate of checklist items during each phase of the study. One hundred and sixteen patients were included, 53 in phase I and 63 in phase II. Eleven patients did not have a checklist in phase II. The overall omission rate of checklist items was significantly lower with checklist (17%) than without (25%) (p = 0.02). This trend increased in proportion to severity with an omission rate of 30% without checklist versus 15% with checklist (p = 0.03) for patients with an ISS ≥ 25. A majority of doctors and nurses who used the checklist considered that it should be made compulsory (82% and 67% respectively). Paradoxically, only 55% of doctors who did not perform the checklist thought it was useful, while the omission rate was significantly higher (17% with checklist compared with 59% without checklist, p < 0.01). This work shows a significant reduction in the number of omissions on the actions carried out during the management of a trauma patient in prehospital settings, allowing better adherence to the recommendations. Its benefit is increased in severely traumatised patients.
Sections du résumé
BACKGROUND
In October 2021, French acute care societies jointly published cognitive aids to standardise practices and limit cognitive biases to ensure greater safety in management of severe trauma patients. The aim of the study was to evaluate the impact of a checklist on emergency physicians' adherence to the recommendations.
METHODS
This prospective before-and-after study study took place in a French mobile emergency and resuscitation service. All adults trauma patients referred to hospital were included. A checklist on trauma management inspired by the MARCHE acronym was produced. During phase I, the checklist was performed within 24 h after the end of the intervention. During phase II, the checklist was performed during the patient's transport to hospital, thus allowing potentially omitted procedures to be performed initially. The use of the checklist was systematically evaluated using an anonymous questionnaire among doctors and nurses. In phase II, doctors and nurses who did not perform checklist were systematically asked to answer a specific online questionnaire. The primary outcome was the overall omission rate of checklist items during each phase of the study.
RESULTS
One hundred and sixteen patients were included, 53 in phase I and 63 in phase II. Eleven patients did not have a checklist in phase II. The overall omission rate of checklist items was significantly lower with checklist (17%) than without (25%) (p = 0.02). This trend increased in proportion to severity with an omission rate of 30% without checklist versus 15% with checklist (p = 0.03) for patients with an ISS ≥ 25. A majority of doctors and nurses who used the checklist considered that it should be made compulsory (82% and 67% respectively). Paradoxically, only 55% of doctors who did not perform the checklist thought it was useful, while the omission rate was significantly higher (17% with checklist compared with 59% without checklist, p < 0.01).
CONCLUSION
This work shows a significant reduction in the number of omissions on the actions carried out during the management of a trauma patient in prehospital settings, allowing better adherence to the recommendations. Its benefit is increased in severely traumatised patients.
Identifiants
pubmed: 37517114
pii: S0735-6757(23)00386-8
doi: 10.1016/j.ajem.2023.07.034
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
113-121Informations de copyright
Copyright © 2023 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest All authors declare no conflict of interest.