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Verkürzung der Versorgungszeit im Trauma-Schockraum für Kinder

Auswirkungen der Einführung eines interdisziplinären Schockraumkonzepts (iTRAPS)

Reduction of treatment time for children in the trauma room care

Impact of implementation of an interdisciplinary trauma room concept (iTRAPS)

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Zusammenfassung

Einleitung

Die reibungslose, interdisziplinäre Zusammenarbeit ist neben infrastrukturellen und konzeptionellen Planungen eine entscheidende Voraussetzung für die zeit- und prioritätenorientierte Versorgung von schwer verletzten Kindern im Schockraum.

Methodik

Die Versorgungszeit im Schockraum vor und nach Implementierung eines neuen, interdisziplinären Schockraumkonzeptes (iTRAPS: interdicziplinary Trauma Room Algorithm in Pediatric Surgery) wurde als Surrogatparameter für die Prozessqualität analysiert. Eingeschlossen wurden Patienten, welche im Kinder-Schockraum aufgrund eines Traumas im Zeitraum von Januar 2014 bis April 2015 (Gruppe 1) und von Juli 2015 bis Januar 2017 (Gruppe 2) behandelt wurden. Einschlusskriterien waren der ISS ≥ 8 und die Notwendigkeit einer CT-Untersuchung im Rahmen der Schockraumversorgung.

Ergebnisse

Vor und nach der Einführung von iTRAPS wurden je 16 Patienten/Gruppe in die Studie eingeschlossen. Hinsichtlich des Alters und des ISS bestand kein signifikanter Unterschied in beiden Gruppen. Die Versorgungzeit im Schockraum konnte signifikant von im Mittelwert (MW) 33,6 min vor der Einführung auf 15,2 min (MW) nach Einführung von iTRAPS reduziert werden (p < 0,01).

Diskussion

Ursächlich für die Reduktion der Versorgungszeit im Schockraum bis zur CT-Diagnostik waren Maßnahmen wie die interdisziplinäre Schockraumleitung, Umstrukturierung der Übergabe inkl. standardisierter Umlagerung des Patienten und die Verbesserung des Patiententransportes.

Schlussfolgerung

Über die interdisziplinär abgestimmte Neuorganisation der Patientenversorgung im Schockraum mit Verbesserung der Infrastruktur und die Einführung standardisierter Versorgungsabläufe konnte die Patientenversorgung verbessert werden.

Abstract

Introduction

In addition to infrastructural and conceptual planning, smooth interdisciplinary cooperation is crucial for trauma room care of severely injured children based on time-saving management and a clear set of priorities. The time to computed tomography (CT) is a well-accepted marker for the efficacy of trauma management. Up to now there are no guidelines in the literature for an adapted approach in pediatric trauma room care.

Methods

A step-by-step algorithm for pediatric trauma room care (Interdisciplinary Trauma Room Algorithm in Pediatric Surgery, iTRAPS) was developed within the framework of an interdisciplinary team: pediatric surgeons, pediatric anaethesiologists, pediatric intensivists and pediatric radiologists. In two groups of patients from January 2014 to April 2015 (group 1) and from July 2015 to January 2017 (group 2) process quality was monitored by the time required for trauma room treatment until the CT scan was performed and used as a surrogate marker. Inclusion criteria were patients aged 0–16 years, who were evaluated in a level 1 pediatric trauma room with an injury severity score (ISS) ≥8 and the necessity for a CT scan.

Results

Before (group 1) and after (group 2) implementation of iTRAPS 16 patients were included in each group. There were no significant differences between the age and the ISS in the two groups of patients. The required time for trauma room treatment was significantly reduced from an average of 33.6 min before to 15.2 min after implementation of iTRAPS (p < 0.01).

Discussion

The required time for the trauma care room treatment could be significantly reduced by more than half after the implementation of iTRAPS. The reasons were the interdisciplinary organization of the trauma room leadership, reorganization of patient transfer and improved briefing by emergency doctors.

Conclusion

Besides a well-organized trauma team, it is essential that the trauma room workflow is adapted to the specific structure of the hospital. Despite the limitations of the study the data demonstrate that the trauma room workflow enables an efficient management. By the interdisciplinary reorganization of the pediatric trauma room treatment with improved structures and standardized processes, patient care was more effective with a significant reduction in the time required for trauma room treatment. The suggested iTRAPS concept could be used as a framework to establish individualized workflows for pediatric trauma room treatment in other hospitals. This algorithm should be supplemented by standardized operating procedures (SOPs) for the differentiated radiological diagnostic procedures in areas of traumatic brain injury (TBI), thoracic and abdominal trauma in children.

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Danksagung

Wir bedanken uns bei Frau Beate Kleine (Leitung Pflege der Kinderintensivstation), Frau Andrea Egeler (Leitung Pflege Kinderanästhesie), Frau Helga Hackel und Frau Johanna Gräber (jeweils Leitung Pflege kinderchirurgische Nothilfe) sowie Frau Sigrid Eberle (leitende MTRA Kinderradiologie) für die vielen konstruktiven Diskussionen, die zur Fertigstellung dieses Manuskripts und der Auswertung der Studie beigetragen haben.

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Authors and Affiliations

  1. Klinik für Kinderchirurgie, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland

    M. Lehner, M. Heinrich, L. Falkenthal & D. Wendling-Keim

  2. Kinderintensivstation, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland

    F. Hoffmann

  3. Kinderradiologie der Klinik und Poliklinik für Radiologie, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland

    B. Kammer

  4. Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität, München, Deutschland

    M. Kurz

  5. Kinderchirurgische Klinik, Kinderspital, Luzerner Kantonsspital, Spitalstrasse 20, 6000, Luzern, Schweiz

    M. Lehner

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  1. M. Lehner
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  6. D. Wendling-Keim
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Corresponding author

Correspondence to M. Lehner.

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Interessenkonflikt

M. Lehner, F. Hoffmann, B. Kammer, M. Heinrich, L. Falkenthal, D. Wendling-Keim und M. Kurz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Lehner, M., Hoffmann, F., Kammer, B. et al. Verkürzung der Versorgungszeit im Trauma-Schockraum für Kinder. Anaesthesist 67, 914–921 (2018). https://doi.org/10.1007/s00101-018-0500-z

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