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Developing and implementing a Theatre Booking and Team Briefing Tool for Major Trauma Cases Requiring Emergency Surgery: Enhancing the Planning, Preparation and Handover Processes��

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Developing and implementing a Theatre booking tool for Major Trauma cases requiring emergency surgery: enhancing the planning, preparation and handover processes

KEY MESSAGES

•Delivering major trauma care is a demanding, high risk process involving a complex care pathway. Transitions of patient care and urgency of intervention make the goal of ensuring reliable, safe care more challenging.
•Within the theatre environment a significant commitment has been made to implement the WHO Safe Surgery Checklist. This aims to standardise communication and shares responsibility for the planning and preparation of theatre.
•A Theatre booking form designed specifically for major trauma cases at NUH was introduced in April 2012 but is not used consistently or reliably, emphasising the difficulty of implementing some new processes in practice.
 
CONTEXT AND PROBLEM

The unpredictable and dynamic nature of major trauma care requires strong leadership skills, effective teamwork and robust communication processes within and between different multi-professional teams along the trauma care pathway.

At Nottingham University Hospital (NUH) major trauma patients requiring emergency surgical management have to be prioritised alongside other patients booked for emergency operations. This creates competition for resources which have to be allocated quickly and seamlessly despite conflicting demands. This process will be aided by the Theatre Co-ordinator having correct and appropriate information about patients in ED undergoing rapid assessment in order to determine the need for immediate or urgent surgical intervention. We aimed to evaluate the existing theatre booking process for major trauma patients, identify key problems in practice, and redesign and test any new system prior to implementation.

RESULTS

•The literature and local data described clear consequences of failure to provide adequate patient information in a time critical manner.
•An existing major trauma theatre booking form was found to be used infrequently and inconsistently, with Co-ordinators favouring a more familiar generic form.

Questionnaire data and focus groups with theatre staff, surgeons and anaesthetists (n=84) distinguished critical versus surplus information for theatre planning, enabling redesign of the form, structured using key information in a chronological systematic manner

This information was used to produce a new form highlighting essential areas in a chronological and logical organisation to aid planning and preparation of theatre. Quality of care was found to be dependent on staff experience so the new form is designed to standardise the transition of care.

NEXT STEPS

The new form is now being tested using desktop simulations based on real cases with theatre coordinators, comparing useability and accuracy of data transmission with the generic form. This will guide further modifications before trialing it in practice. Further steps anticipated include production of a standardised handover proforma to be implemented in the Emergency Department, and evaluation of whether the final theatre booking form also provides a team briefing tool for when the patient arrives in theatres.