How We Did It: Defining roles and preventing crowding in the trauma bay

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Many new trauma programs struggle with trauma bay logistics. How do you get a large team working in concert to deliver organized care in a timely manner? Even experienced teams struggle to optimize workflows and make sure resuscitations run as efficiently as possible.

For this inaugural “How We Did It” column, I spoke with Star Bixby, trauma program manager of UPMC Susquehanna Williamsport Regional Medical Center in Williamsport, Pennsylvania. UPMC Susquehanna recently made the transition from community hospital to regional system referral center. The program is currently working toward Level II verification from the Pennsylvania Trauma Systems Foundation (PTSF).

During our conversation, Star described the logistical and mental challenges of developing an effective trauma team model. She also shared how the UPMC Susquehanna team used some simple solutions to overcome the challenges of role confusion, patient flow and crowd control in the trauma bay.

Q. Star, what has the transition to an “almost” trauma center been like for your team?

Bixby: A lot of work, as expected. It was really a culture change from the ground up. The most unexpected aspect of it was everyone’s fear of the unknown. But once we got over that hurdle, the team moved to “acceptance” for a short time and then quickly to outright embracement. Working with trauma patients is now seen as a source of pride in the hospital.

Q. When the first trauma came in, how did the resuscitation go?

Bixby: At first we didn’t have any protocols or processes firmly in place. So when our first trauma patient came in, the ED tech did a 12-lead EKG while the nurse asked if the patient had gotten a flu shot this season. They approached it in the same way they approach a rule-out MI patient, because that’s what they knew. There wasn’t this concept of the trauma team at all, or the flow of trauma patients through the ER.

Q. Early on, what did you identify as major challenges during the resuscitative phase?

Bixby: Conceptually, it was the fear of the unknown. But more specifically it was defining each team member’s role and the overall flow of how trauma patients are worked up and resuscitated. Another very specific problem was crowd control in the trauma bay. Since trauma was new and there were some dramatic injuries, staff wanted to be in the room and would often jump in and try to help. Well-meaning, but ultimately counterproductive.

Q. How did you solve these problems?

The trauma team at UPMC Susquehanna Williamsport with role stickers and floor markers (click photo to enlarge).

Bixby: In addition to the normal things that everyone does — such as mock traumas, education and proctoring — we did some simple logistic things that made a big difference.

  • First, we very clearly defined roles and a workflow. We did this with a script and flow diagrams.
  • Second, we placed stickers on the floor so each team member would know exactly where to stand when a trauma came in. The stickers are easy-to-read, 9-inch circles that are specially designed for use on the ground. They reinforce roles and also help ensure there isn’t any confusion as to who is involved in the resuscitation and who is just watching.
  • Third, staff were required to wear postcard-size stickers that state their role — ED Doctor, Trauma Doctor, X-Ray Tech and so on. This had a huge impact on clarifying functions and eliminating confusion.

Q. When implementing these solutions, did you run into any unanticipated problems?

An inexpensive postcard rack made it easier for trauma team members to grab a role sticker and helped eliminate clutter.

Bixby: Initially, personal stickers were kept in envelopes, with one set of team stickers per envelope. So when the trauma team was activated, we opened an envelope and people took the sticker they needed. But sometimes, for example, you needed two PA stickers, so people would pilfer extra stickers from different envelopes. Other times, for instance, the family practice resident didn’t show up for the activation, so there would be all these unused stickers floating around.

So what we did was buy an inexpensive postcard rack off Amazon. We mounted the rack next to the gowning station and loaded it with our role stickers. Now, staff members just grab the sticker they need — no need to steal from another envelope and no unused stickers getting underfoot.

In addition, when we switched from the envelope system to the rack system, we changed the sticker colors to correlate with role type. For example, Scribe RN and Primary RN stickers were designated green, Trauma PA and Trauma Doctor stickers were designated orange, etc.

This was a minor adjustment, but it helped reinforce roles and functions. When we added all these small changes together, they really helped us streamline workflows and work together more effectively as a team.

Did you solve an operational problem at your trauma center? Let us know and we might feature your team in an upcoming “How We Did It” column. We are looking for solutions to simple but hard-to-solve problems like how to get surgeons to participate in M&M, how to make sure compartment pressure monitoring kits are returned to where they should be, or simply how to keep people from yelling during resuscitations. If you are proud of a solution you have applied, email us with a brief description.

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