title: Development of the major trauma case review tool.
abstract: BACKGROUND
  As many as half of all patients with major traumatic injuries do not receive the recommended care, with variance in preventable mortality reported across the globe. This variance highlights the need for a comprehensive process for monitoring and reviewing patient care, central to which is a consistent peer-review process that includes trauma system safety and human factors. There is no published, evidence-informed standardised tool that considers these factors for use in adult or paediatric trauma case peer-review. The aim of this research was to develop and validate a trauma case review tool to facilitate clinical review of paediatric trauma patient care in extracting information to facilitate monitoring, inform change and enable loop closure.
  
  
  METHODS
  Development of the trauma case review tool was multi-faceted, beginning with a review of the trauma audit tool literature. Data were extracted from the literature to inform iterative tool development using a consensus approach. Inter-rater agreement was assessed for both the pilot and finalised versions of the tool.
  
  
  RESULTS
  The final trauma case review tool contained ten sections, including patient factors (such as pre-existing conditions), presenting problem, a timeline of events, factors contributing to the care delivery problem (including equipment, work environment, staff action, organizational factors), positive aspects of care and the outcome of panel discussion. After refinement, the inter-rater reliability of the human factors and outcome components of the tool improved with an average 86% agreement between raters.
  
  
  CONCLUSIONS
  This research developed an evidence-informed tool for use in paediatric trauma case review that considers both system safety and human factors to facilitate clinical review of trauma patient care.
  
  
  CONCLUSIONS
  This tool can be used to identify opportunities for improvement in trauma care and guide quality assurance activities. Validation is required in the adult population.
authors.affiliation: Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia.|St George Clinical School, Faculty of Medicine, University of New South Wales, Gray St, Kogarah, NSW, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Curtis
authors.affiliation: Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Mitchell
authors.affiliation: Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: McCarthy
authors.affiliation: NSW Institute of Trauma and Injury Management, Level 4, Sage Building, 67 Albert Avenue, Chatswood, NSW, Australia.
authors.forename: Kellie
authors.initials: K
authors.lastname: Wilson
authors.affiliation: Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia. connie.van@sydney.edu.au.
authors.forename: Connie
authors.initials: C
authors.lastname: Van
authors.affiliation: Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Kennedy
authors.affiliation: NSW Ambulance, Level 2, Sydney Ambulance Centre, Garden St Eveleigh, NSW, 2015, Australia.
authors.forename: Gary
authors.initials: G
authors.lastname: Tall
authors.affiliation: Sydney Medical School, The University of Sydney and The Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Holland
authors.affiliation: Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia.|NorthWestern Mental Health & School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Level 1 North, City Campus, The Royal Melbourne Hospital Grattan Street, Parkville, VIC, 3050, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Foster
authors.affiliation: Human Risk Solutions, Victoria, Australia.
authors.forename: Stuart
authors.initials: S
authors.lastname: Dickinson
authors.affiliation: Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
mesh_terms: D032921:Consensus; D006801:Humans; D008485:Medical Audit / Q000379:methods*; D061214:Patient Safety; D010380:Peer Review; D011787:Quality of Health Care; D014947:Wounds and Injuries / Q000628:therapy
keywords: Adverse event; Emergency; Human factors; Injury; Morbidity; Mortality; Organizational factors; Peer review; Quality; Safety