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Qual Saf Health Care 2005;14:e21 doi:10.1136/qshc.2002.004499
  • Crisis management

Trauma: development of a sub-algorithm

  1. W M Griggs1,
  2. R W Morris2,
  3. W B Runciman3,
  4. G A Osborne4,*,
  5. A D Paix5
  1. 1Director, Trauma Service, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
  2. 2Director of Research and Development, Sydney Medical Simulation Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia
  3. 3Professor and Head, Department of Anaesthesia and Intensive Care, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
  4. 4Senior Staff Specialist, Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
  5. 5Consultant Anaesthetist, Princess Royal University Hospital, Orpington, Kent, UK
  1. Correspondence to:
 Professor W B Runciman
 President, Australian Patient Safety Foundation, GPO Box 400, Adelaide, South Australia, 5001, Australia; researchapsf.net.au
  • Accepted 12 January 2005

Abstract

Background: Anaesthetists are regularly involved in the management of patients who have suffered trauma. Acute physiological derangements can occur at any time after the original injury, with life threatening sequelae. These problems may be complex in nature and evolve rapidly, often with an obscure aetiology, so a systematic approach to them is essential.

Objectives: To examine the role of a previously described core algorithm “COVER ABCD–A SWIFT CHECK” supplemented by a specific sub-algorithm for trauma, in the management of anaesthesia involving trauma cases.

Methods: The potential performance of a structured approach for each of the trauma incidents among the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual performance as reported by the anaesthetists involved.

Results: There were 38 relevant reports relating to trauma in the first 4000 reports to AIMS. In 39% of these there was “emergency corner cutting”, although in the majority the urgency was thought to have been more perceived than real. The previously described “core” crisis management algorithm for crises during general anaesthesia was an effective means of discovering (82%), diagnosing (68%), and correcting (66%) the majority of trauma incidents. However a sub-algorithm specific for the traumatised patient was required for unusual, obscure, or complex presentations.

Conclusion: Although the small numbers preclude validation of the sub-algorithm, it would have successfully managed all the trauma cases reported to AIMS.

Footnotes

  • ↵* Dr Osborne died before this research was published.

  • This study was coordinated by The Australian Patient Safety Foundation, GPO Box 400, Adelaide, South Australia, 5001, Australia.

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