Trauma Patient Transitions: An Exploratory Study of Organizational Variables and Provider Behavior

Abstract

Transitions from the trauma unit require provider handoffs which may result in costly and dangerous errors. This exploratory study describes the processes and resources used when transferring trauma ICU patients from the ICU to other units. The processes and resources based on the Administratively Mediated Variable (AMV) model and hospitals' comparisons on a high reliability (HRO) measurement scale were explored in aims one and two. Provider attitudes, subjective norms, environmental control, and behavioral intentions toward patient transition processes were explored in aim three. Aim one and two methods: a survey of every level one and two trauma centers in the US (N = 567, response rate 27%, total respondents = 152). Results: 51% of administrators reported having a dedicated trauma ICU; 36% reported the use of handoff tools. Physician (MD) models and provider responsibilities varied significantly across trauma centers. Forty percent of respondents reported that MDs received transition education in the last two years. There was demonstrated variability in several resources (labor and non-labor) and processes, but HRO variability was limited. These results can inform national organizations about recommended practices' status. Future research topics include investigations of relationships among AMV and HRO variables and patient outcomes. A robust and feasible HRO instrument is needed to improve HRO measurement. Aim three method: a survey of all trauma ICU providers (N = 130) at a single level one trauma center. The response rate was 70%, total respondents = 72). Results: data collection strategies proved successful. Kruskal Wallis tests demonstrated limited overall variability in attitude, subjective norms, and behavioral intent. Environmental control demonstrated statistically significant variability (p < .05). Sub-category analysis found variability in eight out of 20 categories (p < .05). A topic for future research concerns the existence of variability in a nationally representative sample.