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Education Can Improve Utilization of Closed-Loop Communication, Improving Time-To-Task Completion and Total Time in Trauma Bay
Ibrahim Abdelshafy, MD1; Namoi-LIza A. Denning, New York2; Jennifer A. Delgado, None 2; Francesca A. Bullaro, New York3; Nathan A.M. A. Christopherson, MBA4; Jose M. Prince, New York3
1Cohen Children's Medical Center, Brooklyn, NY; 2Cohen Children's Medical Center, Queens, NY; 3Cohen Children's Medical Center, New Hyde Park, NY; 4Northwell Trauma Institute, New Hyde Park, NY

Improved communication practices such as utilization of closed-loop communication may prevent errors and improve time-to-task completion. We evaluated the impact of pediatric trauma team education on improvement in closed-loop communication, time-to-task completion, and total time-in-trauma bay.

Methods: Trauma activations from 1/2016-5/2017 at a level I pediatric trauma center, were video recorded. Reviewers identified and classified verbal orders issued by the trauma team leader for audibility, directed responsibility, check-back, and time-to-task-completion. Activation level, pre-notification, trauma leader type and total time-in-trauma bay were recorded. Trauma team members were educated regarding the value of closed-loop communication and how to maintain such a practice during trauma activations from 9/ 2016 5/2017. We conducted an analysis comparing time-to-task completion, closed-loop communication, and total time-in-trauma bay for pre-education, education and post-education phases.

Results: In total, 163 trauma activations were reviewed, 88 pre-education, 38 education, 37 post-education. There was a significant difference in the rate of closed-loop communication among all three phases: pre-education, education, and post-education(24.2% vs. 50.5% vs. 43.0% respectively, p<0.0001). There was a significant difference in time-to-task-completion with respect to phase(p<0.0001). For each unit increase in phase, tasks were more likely to be completed 1.2x sooner as compared to the previous phase[HR=1.2 (95% CI: 1.1, 1.4)]. There was an improvement in total time-in-trauma bay with a median of 39 minutes(min) pre-education, 35min education, and 37min post-education.

Conclusion: Pediatric trauma team education may improve utilization of closed-communication, therefore improving time-to-task completion. This highlights the importance of continued education on communication in pediatric trauma.

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