OBJECTIVE This study identified failures in emergency inter-hospital transfer, or re-triage, at high-level trauma centers receiving severely injured patients. SUMMARY BACKGROUND DATA The 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. METHODS This 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. RESULTS A 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). CONCLUSIONS The 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.

中文翻译：

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受伤患者重新分诊到接受高级伊利诺伊州创伤中心的失败模式影响分析。


目的 本研究确定了接收重伤患者的高级创伤中心在紧急院际转移或重新分诊方面的失败。摘要 背景数据 重新分诊过程平均为 4 小时，尽管在 2 小时内及时重新分诊可降低与损伤相关的死亡率。非创伤和低级别创伤中心报告说，大多数严重的失败是在找到一个接受的高级别创伤中心。尚未评估高级创伤中心的严重故障。方法 这是一项在 9 个高级成人创伤中心和 3 个高级儿科创伤中心进行的观察性横断面研究。重新分类过程的失效模式影响分析 （FMEA） 分四个阶段进行。第 1 阶段有目的地对创伤协调员进行抽样，然后对临床医生、手术和领导层进行滚雪球抽样，以确保有代表性的参与。阶段 2 映射了每个重新分类步骤。阶段 3 确定了每个步骤的失败。第 4 阶段对每次故障的影响、频率和检测保障措施进行评分。在第 4 阶段使用标准化评分标准来评估每个故障的影响 （I）、频率 （F） 和检测保护措施 （S），以计算其风险优先级编号 （RPN） （I x F x S）。失败按严重程度进行排名排序。结果 共有 12 个高级创伤中心的 64 名创伤协调员、外科医生、急诊医学医师、护士、运营和质量经理参与。在成人和儿童高级创伤中心发现了 178 例失败。最严重的失败是： 训练有素的运输人员不足 （RPN=648）;从发送到接收中心传输成像的问题 （RPN=400）;临床信息交换不完整 （RPN=384）。 结论 最严重的失败是运输受限以及临床、放射学和到达时间信息交换不完全。需要对这些失败进行进一步调查，包括几个区域，以确定这些发现的可重复性。