• John D Slocum, Jane L Holl, William M Brigode, Mary Beth Voights, Michael J Anstadt, Marion C Henry, Justin Mis, Richard J Fantus, Timothy P Plackett, Eddie J Markul, Grace H Chang, Michael B Shapiro, Nicole Siparsky, and Anne M Stey.
• Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
• Ann. Surg. 2024 Oct 11.

ObjectiveThis study identified failures in emergency inter-hospital transfer, or re-triage, at high-level trauma centers receiving severely injured patients.Summary Background DataThe re-triage process averages four hours despite the fact timely re-triage within two hours mitigates injury-associated mortality. Non-trauma and low-level trauma centers reported most critical failures were in finding an accepting high-level trauma center. Critical failures at high-level trauma centers have not been assessed.MethodsThis was an observational cross-sectional study at nine high-level adult trauma centers and three high-level pediatric trauma centers. Failure Modes Effects Analysis (FMEA) of the re-triage process was conducted in four phases. Phase 1 purposively sampled trauma coordinators followed by snowball sampling of clinicians, operations, and leadership to ensure representative participation. Phase 2 mapped each re-triage step. Phase 3 identified failures at each step. Phase 4 scored each failure on impact, frequency, and safeguards for detection. Standardized rubrics were used in Phase 4 to rate each failure's impact (I), frequency (F), and safeguard for detection (S) to calculate their Risk Priority Number (RPN) (I x F x S). Failures were rank ordered for criticality.ResultsA total of 64 trauma coordinators, surgeons, emergency medicine physicians, nurses, operations and quality managers across twelve high-level trauma centers participated. There were 178failures identified at adult and pediatric high-level trauma centers. The most critical failures were: Insufficient trained transport staff (RPN=648); Issues transmitting imaging from sending to receiving centers (RPN=400); Incomplete exchange of clinical information(RPN=384).ConclusionsThe most critical failures were limited transportation and incomplete exchange of clinical, radiological and arrival timing information. Further investigation of these failures that includes several regions is needed to determine the reproducibility of these findings.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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