Advertisement

Defining obstacles to emergency transfer of trauma patients: An evaluation of retriage processes from nontrauma and lower-level Illinois trauma centers

Published:September 30, 2022DOI:https://doi.org/10.1016/j.surg.2022.08.027

      Abstract

      Background

      Retriage is the emergency transfer of severely injured patients from nontrauma and lower-level trauma centers to higher-level trauma centers. We identified the barriers to retriage at sending centers in a single health system.

      Methods

      We conducted a failure modes effects and criticality analysis at 4 nontrauma centers and 5 lower-level trauma centers in a single health system. Clinicians from each center described the steps in the trauma assessment and retriage process to create a process map. We used standardized scoring to characterize each failure based on frequency, impact on retriage, and prevention safeguards. We ranked each failure using the scores to calculate a risk priority number.

      Results

      We identified 26 steps and 93 failures. The highest-risk failure was refusal by higher-level trauma centers (receiving hospitals) to accept a patient. The most critical failures in the retriage process based on total risk, frequency, and safeguard scores were (1) refusal from a receiving higher-level trauma center to accept a patient (risk priority number = 191), (2) delay in a sending center’s consultant examination of a patient in the emergency department (risk priority number = 177), and (3) delay in receiving hospital’s consultant calling back (risk priority number = 177).

      Conclusion

      We identified (1) addressing obstacles to determining clinical indications for retriage and (2) identifying receiving level I trauma centers who would accept the patient as opportunities to increase timely retriage. Establishing clear clinical indications for retriage that sending and receiving hospitals agree on represents an opportunity for intervention that could improve the retriage of injured patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Newgard C.D.
        • Zive D.
        • Holmes J.F.
        • et al.
        A multisite assessment of the American College of Surgeons Committee on Trauma field triage decision scheme for identifying seriously injured children and adults.
        J Am Coll Surg. 2011; 213: 709-721
        • Xiang H.
        • Wheeler K.K.
        • Groner J.I.
        • Shi J.
        • Haley K.J.
        Undertriage of major trauma patients in the US emergency departments.
        Am J Emerg Med. 2014; 32: 997-1004
        • Newgard C.D.
        • Nelson M.J.
        • Kampp M.
        • et al.
        Out-of-hospital decision making and factors influencing the regional distribution of injured patients in a trauma system.
        J Trauma. 2011; 70: 1345-1353
        • Deane S.A.
        • Gaudry P.L.
        • Woods W.P.
        • Read C.M.
        • McNeil R.J.
        Interhospital transfer in the management of acute trauma.
        Aust N Z J Surg. 1990; 60: 441-446
        • Nielsen E.
        • Skaggs D.L.
        • Harris L.R.
        • Andras L.M.
        Transfer time after acceptance to a level I trauma center.
        J Am Acad Orthop Surg Glob Res Rev. 2018; 2e081
        • Della Valle J.M.
        • Newton C.
        • Kline R.A.
        • Spain D.A.
        • Pirrotta E.
        • Wang N.E.
        Rapid retriage of critically injured trauma patients.
        JAMA Surg. 2017; 152: 981-983
        • Gomez D.
        • Haas B.
        • de Mestral C.
        • et al.
        Institutional and provider factors impeding access to trauma center care: an analysis of transfer practices in a regional trauma system.
        J Trauma Acute Care Surg. 2012; 73: 1288-1293
        • Harrington D.T.
        • Connolly M.
        • Biffl W.L.
        • Majercik S.D.
        • Cioffi W.G.
        Transfer times to definitive care facilities are too long: a consequence of an immature trauma system.
        Ann Surg. 2005; 241 (discussion: 966–968): 961-966
        • Chipko J.
        • Davis D.
        • Cha J.
        • Herron T.
        • Ciesla D.
        Should hypotensive trauma patients ever be transferred to a trauma center?.
        Am Surg. 2019; 85: 1010-1012
        • Newgard C.D.
        • McConnell K.J.
        • Hedges J.R.
        • Mullins R.J.
        The benefit of higher level of care transfer of injured patients from nontertiary hospital emergency departments.
        J Trauma. 2007; 63: 965-971
        • Vassar M.J.
        • Holcroft J.J.
        • Knudson M.M.
        • Kizer K.W.
        Fractures in access to and assessment of trauma systems.
        J Am Coll Surg. 2003; 197: 717-725
        • Nathens A.B.
        • Jurkovich G.J.
        • MacKenzie E.J.
        • Rivara F.P.
        A resource-based assessment of trauma care in the United States.
        J Trauma. 2004; 56 (; discussion: 178): 173-178
        • Stevens D.P.
        • Bowen J.L.
        • Johnson J.K.
        • et al.
        A multi-institutional quality improvement initiative to transform education for chronic illness care in resident continuity practices.
        J Gen Intern Med. 2010; 25: S574-S580
        • Holcomb J.B.
        Transport time and preoperating room hemostatic interventions are important: improving outcomes ofter oevere truncal injury.
        Crit Care Med. 2018; 46: 447-453
        • Hollnagel E.
        Cognitive Reliability and Error Analysis Method: CREAM.
        Elsevier, New York (NY)1998
        • Croskerry P.
        Patient Safety in Emergency Medicine.
        Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia (PA)2009
        • Latino R.J.
        • Flood A.
        Optimizing FMEA and RCA efforts in health care.
        J Healthc Risk Manag. 2004; 24: 21-28
        • Khare R.K.
        • Nannicelli A.P.
        • Powell E.S.
        • Seivert N.P.
        • Adams J.G.
        • Holl J.L.
        Use of risk assessment analysis by failure mode, effects, and criticality to reduce door-to-balloon time.
        Ann Emerg Med. 2013; 62: 388-398
        • Pollack T.A.
        • Illuri V.
        • Khorzad R.
        • et al.
        Risk assessment of the hospital discharge process of high-risk patients with diabetes.
        BMJ Open Qual. 2018; 7e000224
        • Apkon M.
        • Leonard J.
        • Probst L.
        • DeLizio L.
        • Vitale R.
        Design of a safer approach to intravenous drug infusions: failure mode effects analysis.
        Qual Saf Health Care. 2004; 13: 265-271
        • Esmail R.
        • Cummings C.
        • Dersch D.
        • et al.
        Using healthcare failure mode and effect analysis tool to review the process of ordering and administrating potassium chloride and potassium phosphate.
        Healthc Q. 2005; 8: 73-80
        • Steinberger D.M.
        • Douglas S.V.
        • Kirschbaum M.S.
        Use of failure mode and effects analysis for proactive identification of communication and handoff failures from organ procurement to transplantation.
        Prog Transplant. 2009; 19: 208-215
        • Holl J.L.
        • Khorzad R.
        • Zobel R.
        • et al.
        Risk assessment of the door-in-door-out process at primary stroke centers for patients with acute stroke requiring transfer to comprehensive stroke centers.
        J Am Heart Assoc. 2021; 10e021803
        • Burgmeier J.
        Failure mode and effect analysis: an application in reducing risk in blood transfusion.
        Jt Comm J Qual Improv. 2002; 28: 331-339
        • McElroy L.M.
        • Khorzad R.
        • Nannicelli A.P.
        • Brown A.R.
        • Ladner D.P.
        • Holl J.L.
        Failure mode and effects analysis: a comparison of two common risk prioritisation methods.
        BMJ Qual Saf. 2016; 25: 329-336
        • Williams C.
        • Weston R.
        • Feinglass J.
        • Crandall M.
        Pediatric bicycle helmet legislation and crash-related traumatic brain injury in Illinois, 1999-2009.
        J Surg Res. 2018; 222: 231-237
        • DeRosier J.
        • Stalhandske E.
        • Bagian J.P.
        • Nudell T.
        Using health care failure mode and effect analysis: the VA National Center for Patient Safety's prospective risk analysis system.
        Jt Comm J Qual Improv. 2002; 28: 248-289
        • Bertolini M.
        • Bevilacqua M.
        • Roberto M.
        FMECA approach to product traceability in the food industry.
        Food Control. 2006; 17: 137-145
        • Lifar A.S.
        • Brom A.E.
        FMECA Use for the equipment reliability analysis in hydro-power engineering.
        IOP Conf Ser: Earth Environ Science. 2019; 272e032192
        • Adhikary D.D.
        • Bose G.K.
        • Bose D.
        • Mitra S.
        Multi criteria FMECA for coal-fired thermal power plants using COPRAS-G.
        Int J Qual Reliab Manag. 2014; 31: 601-614
        • Bevilacqua M.
        • Braglia M.
        • Gabbrielli R.
        Monte Carlo simulation approach for a modified FMECA in a power plant.
        Qual Reliab Eng Int. 2000; 16: 313-324
        • Petrovic M.A.
        • Aboumatar H.
        • Baumgartner W.A.
        • et al.
        Pilot implementation of a perioperative protocol to guide operating room-to-intensive care unit patient handoffs.
        J Cardiothorac Vasc Anesth. 2012; 26: 11-16
        • Thornton V.L.
        • Holl J.L.
        • Cline D.M.
        • Freiermuth C.E.
        • Sullivan D.T.
        • Tanabe P.
        Application of a proactive risk analysis to emergency department sickle cell care.
        West J Emerg Med. 2014; 15: 446-458
        • Gilliam M.L.
        • Mistretta S.Q.
        • Martins S.L.
        • Holl J.L.
        A systematic approach to improving intrauterine device services in family planning clinics.
        Contraception. 2014; 90: 542-547
        • Powell E.S.
        • O’Connor L.M.
        • Nannicelli A.P.
        • et al.
        Failure mode effects and criticality analysis: innovative risk assessment to identify critical areas for improvement in emergency department sepsis resuscitation.
        Diagnosis. 2014; 1: 173-181
        • Kaufmnan J.
        • Twite M.
        • Barrett C.
        • et al.
        A handoff protocol from the cardiovascular operating room to cardiac ICU is associated with improvements in care beyond the immediate postoperative period.
        Jt Comm J Qual Patient Saf. 2013; 39: 306-311
        • McElroy L.M.
        • Collins K.M.
        • Koller F.L.
        • et al.
        Operating room to intensive care unit handoffs and the risks of patient harm.
        Surgery. 2015; 158: 588-594
        • Brost N.
        • Crilly J.
        • Wallis M.
        • Patterson E.
        • Chaboyer W.
        Clinical handover of patients arriving by ambulance to the emergency department, a literature review.
        Int Emerg Nurs. 2020; 18: 210-220
        • Cwinn M.A.
        • Forster A.J.
        • Cwinn A.A.
        • Hebert G.
        • Calder L.
        • Stiell I.G.
        Prevalence of information gaps for seniors transferred from nursing homes to the emergency department.
        CJEM. 2009; 11: 462-471
        • Jones J.S.
        • Dwyer P.R.
        • White L.J.
        • Firman R.
        Patient transfer from nursing home to emergency department: outcomes and policy implications.
        Acad Emerg Med. 1997; 4: 908-915