title: Barriers to trauma patient care associated with CT scanning.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: Renaldo C
authors.initials: RC
authors.lastname: Blocker
authors.forename: Daniel
authors.initials: D
authors.lastname: Shouhed
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gangi
authors.forename: Eric
authors.initials: E
authors.lastname: Ley
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blaha
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Gewertz
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Wiegmann
authors.forename: Ken R
authors.initials: KR
authors.lastname: Catchpole
mesh_terms: D003625:Data Collection / Q000379:methods; D057210:Delayed Diagnosis / Q000517:prevention & control; D017598:Efficiency, Organizational; D004638:Emergency Treatment / Q000379:methods / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D010348:Patient Care Team / Q000458:organization & administration; D017064:Process Assessment, Health Care; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000592:standards*; D014193:Trauma Centers / Q000458:organization & administration*