title: A human factors subsystems approach to trauma care.
abstract: OBJECTIVE
  A physician-centered approach to systems design is fundamental to ameliorating the causes of many errors, inefficiencies, and reliability problems.
  
  
  OBJECTIVE
  To use human factors engineering to redesign the trauma process based on previously identified impediments to care related to coordination problems, communication failures, and equipment issues.
  
  
  METHODS
  This study used an interrupted time series design to collect historically controlled data via prospective direct observation by trained observers. We studied patients from a level I trauma center from August 1 through October 31, 2011, and August 1 through October 31, 2012.
  
  
  METHODS
  A range of potential solutions based on previous observations, trauma team engagement, and iterative cycles identified the most promising subsystem interventions (headsets, equipment storage, medication packs, whiteboard, prebriefing, and teamwork training). Five of the 6 subsystem interventions were successfully deployed. Communication headsets were found to be unsuitable in simulation.
  
  
  METHODS
  The primary outcome measure was flow disruptions, with treatment time and length of stay as secondary outcome measures.
  
  
  RESULTS
  A total of 86 patients were observed before the intervention and 120 after the intervention. Flow disruptions increased if the patient had undergone computed tomography (CT) (F1200 = 20.0, P < .001) and had been to the operating room (F1200 = 63.1, P < .001), with an interaction among the intervention, trauma level, and CT (F1200 = 6.50, P = .01). For total treatment time, there was an effect of the intervention (F1200 = 21.7, P < .001), whether the patient had undergone CT (F1200 = 43.0, P < .001), and whether the patient had been to the operating room (F1200 = 85.8, P < .001), with an interaction among the intervention, trauma level, and CT (F1200 = 15.1, P < .001), reflecting a 20- to 30-minute reduction in time in the emergency department. Length of stay was reduced significantly for patients with major mortality risk (P = .01) from a median of 8 to 5 days.
  
  
  CONCLUSIONS
  Deployment of complex subsystem interventions based on detailed human factors engineering and a systems analysis of the provision of trauma care resulted in reduced flow disruptions, treatment time, and length of stay.
authors.forename: Ken
authors.initials: K
authors.lastname: Catchpole
authors.forename: Eric
authors.initials: E
authors.lastname: Ley
authors.forename: Doug
authors.initials: D
authors.lastname: Wiegmann
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blaha
authors.forename: Daniel
authors.initials: D
authors.lastname: Shouhed
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gangi
authors.forename: Renaldo
authors.initials: R
authors.lastname: Blocker
authors.forename: Richard
authors.initials: R
authors.lastname: Karl
authors.forename: Cathy
authors.initials: C
authors.lastname: Karl
authors.forename: Bill
authors.initials: B
authors.lastname: Taggart
authors.forename: Benjamin
authors.initials: B
authors.lastname: Starnes
authors.forename: Bruce
authors.initials: B
authors.lastname: Gewertz
mesh_terms: D006804:Ergonomics; D017144:Focus Groups; D006801:Humans; D033183:Interdisciplinary Communication; D065186:Interrupted Time Series Analysis / Q000379:methods; D007902:Length of Stay; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D013597:Systems Analysis; D018511:Systems Integration; D061665:Time-to-Treatment; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*