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Standardizing the initial resuscitation of the trauma patient with the Primary Assessment Completion Tool (PACT) using video review
Lee Ann Wurster MS, RN, CPNP1, Rajan Thakkar, MD2, Jonathan Groner, MD3. 1Nationwide Children's Hospital, Columbus, Ohio, USA, 2Nationwide Children's Hospital, Columbus, Ohio, USA, 3Nationwide Children's Hospital, Columbus, Ohio, USA.

Background: At pediatric trauma centers, major resuscitations are relatively uncommon and therefore at increased risk for error. The Advanced Trauma Life Support (ATLS) treatment paradigm was established to reduce variability and improve the initial management of trauma patients, and has been shown to improve outcomes. Attrition of ATLS knowledge occurs even in major trauma centers. The goal of this quality improvement project was to reduce variability in the ATLS primary assessment for major resuscitations.

Methods: We conducted video review of major resuscitations at a level 1 pediatric trauma center. A tool was developed to score the assessment physician on completion of ATLS components: airway, breathing, circulation, disability and exposure. An acceptable score was ?85 (maximum 100). Interventions used to improve performance included: bimonthly mock traumas, monthly reviews of scores at trauma performance improvement meetings, and email notifications of scores to the responsible surgeon. In addition, these scores were incorporated into each surgeon's annual performance review.

Results: Baseline data showed that only 2/21 (9.5%) of the physician scores were ?85. Thirty days following project implementation, 5/11 (45.5%) had scores ?85. Six months following project implementation, 39/54 (72.2 %) scored ?85. These are statistically significant changes (p<.0001) with less score variability over time.

Conclusions: Because poor compliance with ATLS format can lead to missed injuries and potential harm to the trauma patient, standardization of this high acuity process is essential. This quality improvement project improved compliance with ATLS format and decreased variability by the assessment physicians, potentially improving patient safety and outcomes.

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