title: Standardizing the initial resuscitation of the trauma patient with the Primary Assessment Completion Tool using video review.
abstract: Major trauma resuscitations at pediatric trauma centers have an elevated risk for error because of their high acuity and relatively low frequency. The Advanced Trauma Life Support (ATLS) treatment paradigm was established to improve the management of trauma patients during the initial resuscitation phase and has been shown to improve outcomes through a standardized approach. The goal of this quality improvement project was to decrease assessment physician variability and improve the compliance with the ATLS primary assessment for major resuscitations.
  
  
  
  A video review tool was developed to score the assessment physician on completion of the primary survey components using ATLS format. Interrater reliability and content validity were established for the tool. Data were collected through video review of the trauma response team in the emergency department for all Level 1 trauma alert activations with general consent. Chi-square and regression analyses were used to evaluate the data at 30 days, 6 months, and 1 year from the baseline period.
  
  
  
  A total of 142 patient videos were scored between July 28, 2015, and August 1, 2016. Eleven patients were reviewed during the baseline period, and only 9.1% of the total scores were ≥85. Thirty days following project implementation, 37.5% were ≥ 85. Six months following project implementation, 64.4% scored ≥85. One year following project implementation, 91.5% scored ≥85. These were statistically significant changes (p < .0001) with less variability over time.
  
  
  
  Effective leadership using a standardized approach during the trauma resuscitation has been found to have a positive effect on task completion and the overall functioning of the trauma team. This focused quality improvement project improved compliance with ATLS format and decreased variability by the assessment physician, potentially improving patient safety and outcomes.
  
  
  
  Therapeutic/care management study, level IV.
authors.affiliation: From the Department of Pediatric Surgery (R.K.T., J.I.G.), Center for Pediatric Trauma Research (K.K.W.), and Emergency Department (J.L., M.S., Y.G., T.H.), Nationwide Children's Hospital (L.A.W., K.J.H., D.B.), Columbus, Ohio.
authors.forename: Lee Ann
authors.initials: LA
authors.lastname: Wurster
authors.forename: Rajan K
authors.initials: RK
authors.lastname: Thakkar
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Haley
authors.forename: Krista K
authors.initials: KK
authors.lastname: Wheeler
authors.forename: Jeremy
authors.initials: J
authors.lastname: Larson
authors.forename: Michael
authors.initials: M
authors.lastname: Stoner
authors.forename: Yaffa
authors.initials: Y
authors.lastname: Gewirtz
authors.forename: Todd
authors.initials: T
authors.lastname: Holman
authors.forename: Don
authors.initials: D
authors.lastname: Buckingham
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Groner
mesh_terms: D000293:Adolescent; D061906:Advanced Trauma Life Support Care / Q000379:methods / Q000592:standards; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods / Q000592:standards*; D014193:Trauma Centers / Q000592:standards; D014741:Video Recording; D014947:Wounds and Injuries / Q000628:therapy*