Finding success: implementing a trauma tertiary survey at a level 1 trauma center

Introduction: To mitigate missed injuries, we implemented a standardized trauma tertiary survey (TTS), consisting of a comprehensive patient re-evaluation within 48 hours of admission. Using survey data of all key stakeholders, we analyzed what factors were perceived by surgical providers as important to successful TTS implementation. Methods: A TTS was protocolized at a level-1 trauma center from January 2019 to January 2020. The protocol design involved all key stakeholders and emphasized ease-of-use by including electronic medical record (EMR) integration, drop-down menus, and pre-filled fields. After the 1-year period, a 13-question survey was emailed to all members of the trauma team, to assess provider attitudes towards the efficacy of TTS implementation. Success was defined by combining agreement in 3 separate survey responses that alluded to efficiency in workflow, improved patient outcomes, and perceived effectiveness of the TTS as a quality improvement tool. Responses of stakeholders who found survey implementation successful were compared to those who did not. Factors significant on initial analysis were included in a regression analysis to find independent predictors of successful TTS implementation. Results: 862 consecutive TTSs were performed. The survey was completed by 50 participants including 6 attending physicians, 3 advanced practice clinicians, and 41 surgical residents. On univariate analysis, ease of use, adequate preparedness, and a preference for continued use were correlated with attitudes towards successful TTS implementation. On multivariate regression, ease of use was the most important predictor of success. Conclusions: Ease of use may be the most important factor in ensuring success in initiating a TTS. As hospital systems focus more on quality healthcare delivery, factors such as EMR integration that prioritize ease use, may represent best practices for successful TTS implementation.