Standardizing the initial resuscitation of the trauma patient with the Primary Assessment Completion Tool (PACT) using video review.

Background: Major trauma resuscitations at pediatric trauma centers have an elevated risk for error due to their high acuity and relatively low frequency. The Advanced Trauma Life Support(R) (ATLS(R)) treatment paradigm was established to improve the management of trauma patients during the initial resuscitation phase and has been shown to improve outcomes through a standardized approach. The goal of this quality improvement project was to decrease assessment physician variability and improve the compliance with the ATLS(R) primary assessment for major resuscitations. Methods: A video review tool was developed to score the assessment physician on completion of the primary survey components using ATLS format. Inter-rater reliability and content validity were established for the tool. Data were collected through video review of the trauma response team in the emergency department for all level 1 trauma alert activations with general consent. Chi-square and regression analyses were used to evaluate the data at 30 days, six months and one year from the baseline period. Results: A total of 142 patient videos were scored between July 28, 2015 and August 1, 2016. Eleven patients were reviewed during the baseline period and only 9.1% of the total scores were >= 85. Thirty days following project implementation, 37.5% were >= 85. Six months following project implementation, 64.4% scored >= 85. One year following project implementation, 91.5% scored >= 85. These were statistically significant changes (p<.0001 with less variability over time. conclusions: effective leadership using a standardized approach during the trauma resuscitation has been found to have positive effect on task completion and overall functioning of team. this focused quality improvement project improved compliance atls format decreased by assessment physician potentially improving patient safety outcomes. level evidence: therapeutic management study iv lippincott williams wilkins inc.>

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