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Application of Change Management Techniques during FAST Implementation in Trauma Code Activations within the Paediatric Emergency Department
Lianne J. McLean, MD, MB, BCh, BAO, FRCPC, Tania Prinicpi, MD, MSc, FRCPC, Suzanne Beno, MD, FRCPC, Jason W. Fischer, MD. University of Toronto, Hospital for Sick Children, Division of Emergency Medicine, Toronto, ON, Canada.

Background: Focused Assessment with Sonography in Trauma (FAST) is used in adult traumas to assess for the presence of free fluid in the abdomen and thorax. Efforts are underway to research the applicability of FAST in paediatric trauma activations. The aim of this study was increase the utilization of FAST during traumas in our Paediatric Emergency Department.

Methods: This is a prospective cohort quality improvement study done in a pediatric tertiary care Level 1 trauma center. Education was undertaken to train Paediatric Emergency faculty, fellows and Paediatric Surgery fellows in FAST as well implementation of a staged iterative process, simulation cases, feedback and competency assessments. Surveys were distributed to trauma team members after all traumas to assess for perceived barriers and integration into the trauma assessment.

Results: From October 2014 March 2016, 101 FAST scans were assessed. Over the course of the study the utilization of FAST increased from 43% of total traumas, (60% of those surveyed) in the first month, to 82% of surveyed activations subsequently. Staff who had completed competency assessment increased, with FAST completion consistently less than five minutes. Hindrance and distraction scores were low from the onset of the study and remained constant at less than 3.5/10 throughout the study period.

Conclusions: Perceptions and total number of scans improved over the course of this study, with hindrance and distraction measures staying constant. This study supports a multidisciplinary staged implementation of FAST into trauma activations, demonstrating the possibilities of iterative change in integrating new modalities in trauma care.


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