Analyzing the Effectiveness of a Pre-Arrival Time-Out in Pediatric Trauma Resuscitations

Abstract

BACKGROUND: The surgical time-out is standard practice in the operating room. Time-out protocols have been associated with improved care and decreased complications in nonurgent care. However, the use of time-outs in trauma settings is not well studied and no standardized time-out exists. Early trauma time-out studies have found that these time-outs are perceived as effective and help reduce complications. The goal of this study was to draft a pre-arrival time-out protocol at Riley Hospital for Children (RHC), emphasizing introductions, patient details, and the patient’s plan upon arrival. METHODS: In this study, pre-hospital preparation for trauma resuscitations were retrospectively reviewed using trauma video review (TVR). Resuscitations took place in one of four trauma bays at RHC. The TVR analyzed pre-hospital preparations before a formal time-out plan was drafted for items related to the trauma time-out. Twenty-four resuscitations with pre-arrival interactions were available in the TVR for analysis. At the conclusion of this project, a pre-arrival time-out plan was drafted and implemented by invested healthcare professionals. RESULTS: Before intervention, time-outs occurred 29.2% (7/24) of the time. Attendance at time-outs was 76.2±11.7%. The average length of time-outs was 59.6±19.4 seconds and the average time between the end of the time-out and patient arrival was 4 minutes 53.7 seconds ± 3 minutes 37.0 seconds. Introductions were fully completed in 16.7% (4/24) of all scenarios and 57.1% (4/7) of all scenarios with time-outs. A clear leader was identified in 29.2% (7/24) of cases. Discussions about the case occurred 83.3% (20/24) of the time. A stated need for an item occurred in 50.0% (12/24) of pre-hospital preparations. CONCLUSION: The rates of time-outs, introductions, stating patient details, and stating equipment needs before patient arrival is less than desirable. The pre-arrival time-out intervention could be effective in increasing these rates. More data for post-intervention is needed.