Jennifer Blaha

Flow Disruptions in Trauma Surgery: Type, Impact, and Affect

The objective of this study was to identify and understand all components of the trauma care process to mitigate the systemic challenges faced by clinicians attempting to deliver the best trauma care. The study was conducted using a prospective data collection method. An interdisciplinary team of researchers observed 87 cases over a 10-week period and identified 1759 flow disruptions. There were a higher number of flow disruptions per case in the operating room (M=61.3, ±36.72) than in the emergency department (M=9.2, ±1.77) or radiology (M=7.5, ±2.01). Focusing on the OR, the majority of the flow disruptions identified in the OR were due to either coordination issues (28%) or communication breakdowns (24%). Roughly 12% of disruptions resulted in moderate delays or full case cessation. This study demonstrates the value of using flow disruptions as a surrogate for efficiency and quality outcome measures, and as a diagnostic method for understanding higher order problems in the system of trauma care.

Bottleneck Analysis to Reduce Surgical Flow Disruptions: Theory and Application

The work flow of surgical operations in emergency department and operating rooms can be interrupted due to various disruptions. Reducing such disruptions is of significant importance to ensure successful operations. In this paper, we introduce a continuous-time Markov chain model to analyze the disruptions and their impacts. Analytical formulas have been derived to evaluate the probabilities of normal operations and disruptions. A continuous improvement method has been developed to identify the disruption that impedes surgical operation in the strongest manner. Such a disruption is referred to as the bottleneck disruption. Specifically, the bottleneck disruption can be further categorized with respect to interruption time (BN- t) and frequency (BN- f), so that reducing the interruption time and frequency of the bottleneck, respectively, can lead to the largest improvement in normal operation. An application of the method at an emergency department of a large academic medical center is presented to illustrate the effectiveness of the model and the improvement approach.

Barriers to Trauma Patient Care Associated with CT Scanning

BACKGROUND Trauma care is often delivered to unstable patients with incomplete medical histories, under time pressure, and with a need for multidisciplinary collaboration. Trauma patient flow through radiology is particularly prone to deviations from optimal care. A better understanding of this process could reduce errors and improve quality, flow, and patient outcomes. STUDY DESIGN Disruptions to the flow of trauma care during trauma activations were observed over a 10-week period at a level I trauma center. Using a validated data collection tool, the type, nature, and impact of disruptions to the care process were recorded. Two physicians unaffiliated with the study conducted a post hoc, blinded review of the flow disruptions and assigned a clinical impact score to each. RESULTS There were 581 flow disruptions observed during the radiologic care of 76 trauma patients. An average of 30.5 minutes (95% CI, 27-34; median, 29; interquartile range, 20-38) was spent in the CT scanner, with a mean of 14.5 flow disruptions per hour (95% CI, 11.8-17.2). Coordination problems (34%), communication failures (19%), interruptions (13%), patient-related factors (12%), and equipment issues (8%) were the most frequent disruption types. Flow disruptions with the highest clinical impact were generally related to patient movements while in the scanner, problems with ordering systems, equipment unavailability, and ineffective teamwork. CONCLUSIONS Although flow disruptions cannot be eliminated completely, specific targeted interventions are available to address the issues identified.