Digital health technology and trauma: development of an app to standardize care

A clinical observation algorithm for anterior abdominal stab wound is safe in an Australian setting

INTRODUCTION

We previously published the outcomes associated with the use of diagnostic laparoscopy to determine peritoneal breach for AASW patients without an immediate indication for laparotomy. Although this pathway was 100% sensitive there was a 54% non-therapeutic laparotomy rate. Another option that has been extensively reported is the clinical observation algorithm (COA) however, majority of the data originate from high-volume centres. We hypothesized that a COA would also be a safe option in an Australian setting, and reduce the rate of non-therapeutic operative intervention in managing AASW.

METHODS

This was a prospective cohort study examining patients with AASW admitted to a level 1 trauma centre in Sydney, Australia, between June 2021 and August 2023. Patient, injury, management and outcome data were collected from electronic medical records and the hospital trauma registry. Data were then analysed to determine the diagnostic accuracy of the COA, complication rates and median hospital length-of-stay (LOS).

RESULTS

A total of 48 patients presented with AASW. Of these patients, 11 (22.9%) proceeded to immediate laparotomy. Seven patients had a contraindication to COA and underwent diagnostic laparoscopy. Thirty patients were managed with the COA, with three (10%) patients subsequently requiring a laparotomy. Only one patient (3.3%) underwent a non-therapeutic laparotomy. There were no missed injuries. The COA sensitivity was 100%, specificity 92.7%, PPV 50% and NPV 100%. Patients managed with COA had no complications. Overall median hospital LOS was 1 day (1.0-2.3).

CONCLUSION

A COA is a safe approach for evaluating patients with AASW in an Australian setting with adequate resources. It reduces the rate of non-therapeutic operative intervention and has acceptable outcomes compared with a diagnostic laparoscopy pathway.

A look to the future: Pandemic-induced digital technologies in vascular surgery

Like many areas of medicine, vascular surgery has been transformed by the COVID-19 (coronavirus disease 2019) pandemic. Public health precautions to minimize disease transmission have led to reduced attendance at hospitals and clinics in elective and emergency settings; fewer face-to-face and hands-on clinical interactions; and increased reliance on telemedicine, virtual attendance, investigations, and digital therapeutics. However, a “silver lining” to the COVID-19 pandemic may be the mainstream acceptance and acceleration of telemedicine, remote monitoring, digital health technology, and three-dimensional technologies, such as three-dimensional printing and virtual reality, by connecting health care providers to patients in a safe, reliable, and timely manner, and supplanting face-to-face surgical simulation and training. This review explores the impact of these changes in the delivery of vascular surgical care.

Quality use of diagnostic imaging in trauma, and the impact on emergency medical practice-a retrospective clinical audit

PURPOSE

The current study aimed to evaluate the appropriateness of the decisions made to order diagnostic imaging for emergency trauma patients.

METHODS

A retrospective audit of 642 clinical decisions for 370 non-consecutive trauma cases was conducted at a level 1 adult trauma centre. Radiographs and computed tomography investigations were compared for compliance with the American College of Radiology/European Society of Radiology (ACR/ESR) imaging guidelines. The non-compliant imaging orders were evaluated for the following medical officer ranks: Junior Medical Officer (JMO), Senior Resident Medical Officer (SRMO), Emergency Medicine Registrar (EMR) and Consultants/Career Medical Officer (CMO). The time of imaging order (day/evening or night shift), whether the imaging led to conservative or surgical patient management, and whether the imaging order decisions led to a change in the clinical management of the patient were also considered.

RESULTS

Non-compliance with the ACR/ESR guidelines was low. At least half of non-compliant decisions made by each level of medical officer resulted in a change in patient management. In total, 11 (65%), 25 (53%), 12 (63%) and 11 (52%) of non-compliant imaging orders placed by JMOs, SRMOs, EMRs and Consultants, respectively, resulted in change of patient management. JMOs and SRMOs ordered a significantly higher proportion of non-compliant imaging studies for conservatively managed patients in comparison to surgically managed patients.

CONCLUSION

This study highlighted that most non-compliant imaging orders benefited the patient.

Re-thinking Digital Health: Data, Appisation and the (im)possibility of 'Opting out'

Presented as providing cost-, time- and labour- effective tools for the (self)management of health, health apps are often celebrated as beneficial to all. However, their negative effects - commodification of user data and infringement on privacy - are rarely addressed. This article focuses on one particularly troubling aspect: the difficulty of opting out of data sharing and aggregation during app use or after unsubscribing/uninstalling the app. Working in the context of the new European General Data Protection Regulation and its implementation in the UK health services, our analysis reveals the discrepancy between the information presented to users, and the apps' actual handling of user data. We also point to the fundamental tension in the digitisation of health, between the neoliberal model where both health and data concerns are viewed as an individual's responsibility, and the digital-capitalist model, which puts forward, and capitalises on, collective ('Big') data. Pulled between the 'biopolitics of the self' and the 'biopolitics of the population' (concepts coined by Btihaj Ajana), opting out of health datafication therefore cannot be resolved as a matter of individual right alone. The article offers two contributions. Methodologically, we present a toolkit for a multi-level assessment of apps from the perspective of opting out, which can be adapted and used in future research. Conceptually, the article brings together critical digital health scholarship with the perspective of data justice, offering a new approach to health apps, which focuses on opt-out as a legal, social and technical possibility, and as a collective citizen and user right.

The impact of simulated multidisciplinary Trauma Team Training on team performance: A qualitative study

INTRODUCTION

Effective teamwork is imperative in the emergency trauma setting as trauma teams work in the uncertain and complex context of resuscitating critically injured patients. Poorly performing teams have the potential to contribute to adverse events. Efforts to improve teamwork in trauma include simulation-based multidisciplinary team training with a non-technical skills (NTS) focus. However, there is a lack of evidence linking teamwork training programs with the uptake of NTS in real life trauma resuscitations. The aim of this study was to understand trauma team members' perspectives and experiences of teamwork in real world trauma resuscitations at a Level 1 Trauma Hospital, following completion of a simulated multidisciplinary Trauma Team Training (TTT) program.

METHOD

Semi-structured interviews were used to explore trauma team members' experiences and perspectives of the impact of TTT on the team's performance. Trauma team members who had completed TTT were invited to participate in the study. Fifteen participants from various disciplines (nursing, medical, allied health) and specialities (emergency, intensive care, trauma, anaesthetics, allied health) were interviewed. Qualitative data were thematically analysed.

RESULTS

The overarching finding was that teamwork was the essential component to facilitate a group of skilled experts to collectively perform at an optimum level in emergency trauma care. Four main themes were developed: Leader-follower synergy promotes trauma teamwork; Instability and inconsistency threaten trauma teamwork; Clear communication enhances trauma team decision-making and Team training improves trauma team performance.

CONCLUSION

A quickly constructed specialty team with unstable membership, will not transform naturally into an expert trauma team. The creation and maintenance of effective trauma teams requires training strategies such as multidisciplinary simulation that target team training and team interaction. Specifically, training should focus on developing non-technical skills for resuscitation trauma teams that have to form quickly and function effectively, often having never met before. As participants were overwhelmingly female, the data generated by this study are not necessarily generalisable to male members of trauma teams.

Enhancing the training of trauma resuscitation flash teams: A mixed methods study

AIMS

To determine whether simulated multidisciplinary team training influences teamwork practices and experiences when resuscitating critically injured patients and to generate evidence for training trauma resuscitation flash teams.

BACKGROUND

Trauma teams perform in stressful situations. They are 'flash' teams, mobilised quickly and comprise of different specialties and disciplines. Simulation is promoted as a training strategy. Significant gaps remain in evaluating the impact of this training on clinical practice. Further research is warranted to determine the most effective way to train trauma resuscitation flash team.

DESIGN

Final integration phase of a mixed methods embedded experimental study.

METHODS

Primary quantitative results (time to critical operations, facilitators and barriers to teamwork) were merged with supplementary qualitative results (team members' experiences and perspectives) to explain the influences of simulated multidisciplinary trauma team training on teamwork and patient outcomes.

RESULTS

Four main themes were developed: communication needs to be specific to the emergency context; collaborative decision-making influences resuscitation situations; standardisation promotes efficient trauma care; proficient leadership empowers multidisciplinary teamwork.

CONCLUSION

Frontline clinicians identified real-world experiences that enable or impede team performance in trauma resuscitations. Our findings ascertain why multidisciplinary team training enhances team performance and what content should be incorporated in training programmes.