Using video audit to improve trauma resuscitation--time for a new approach

• Published in: Canadian Journal of Surgery 2006-06, Vol.49 (3), p.208-211
• Main Authors: Fitzgerald, Mark, Gocentas, Rob, Dziukas, Linas, Cameron, Peter, Mackenzie, Colin, Farrow, Nathan
• Format: Article
• Language: English
• Subjects: Care and treatment; Humans; Management; Medical Audit - methods; Medical equipment; Medical technology; Patient outcomes; Prognosis; Quality Assurance, Health Care; Resuscitation - standards; Resuscitation - trends; Trauma; Trauma and Critical Care; Trauma centers; Trauma Centers - standards; Traumatology; Video; Wounds and injuries
• ISSN: 0008-428X; 1488-2310

It is difficult to measure objectively process changes in the resuscitation environment without video audit. Subjective, retrospective recall following the hectic few minutes of trauma resuscitation is likely to be Hawed. Video recordings of trauma reception and resuscitation can be audited using objective criteria or specific performance indicators. This allows the scrutiny of a specific aspect of trauma resuscitation: for example, team leader performance using a validated measurement tool,37 trauma resuscitation time and time to procedural intervention,44 and the adequacy of universal precautions during trauma resuscitation.45 Videotapes/discs of trauma reception and resuscitation arE usually audited using a process based on peer or expert review. This may allow a more global assessment of trauma resuscitations. With this approach, video audit of trauma resuscitation can identity system and process issues in trauma management,41,46 including the factors underlying, for example, prolonged uncorrected esophageal intubation39 or thoracostomy tuhe insertion.47 It has also been used to assess the impact of ATLS training on trauma resuscitations. A video au dit study from a level 1 United States trauma centre found an initial 23% deviation from ATLS resuscitation principles.48 In Australia, the Victorian Major Trauma Services58 are developing a scalable and exportable computer-prompted algorithm system for real-time use on patients with major trauma. Compliance will be guided by point-of-care, integrated resuscitation treatment algorithms and real-time computer-generated prompts. These algorithms will define the standard of care for trauma resuscitations in that study. Based on this treatment standard, an objective audit tool can be developed that will measure compliance with prompts and overcome the subjective nature and flawed reliability of expert opinion that has been a critical weakness in preventablemortality studies and video audit for trauma to date. A video data acquisition system will intermittently overlay patient monitoring data onto the video recording.59 A prospective, controlled, randomized trial is needed to evaluate the effectiveness of video audit in verifying compliance, error rates and subsequent patient outcomes. The goal is to reduce error through standardized decision-making, leading to a reduction in both preventable mortality and morbidity for patients with major trauma.