Implementation Effect of a Trauma Tertiary Survey in the Electronic Health Record
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Borth, Amy
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Abstract
Problem & Purpose: Despite Advanced Trauma Life Support guidelines recommending comprehensive trauma evaluations, a major mid-Atlantic urban trauma center lacked a formalized tertiary survey, leading to 42 missed injuries in fiscal year 2022-2023. Delayed diagnoses, occurring in 1% to 39% of trauma cases, can prolong hospital stays, require additional procedures, and increase mortality. Standardized tertiary surveys have been shown to reduce missed injuries and improve documentation. This quality improvement project aimed to implement a standardized, electronic trauma tertiary survey within the electronic health record (EHR) to reduce missed injuries. Methods: A fishbone analysis at a 110-bed trauma center, admitting ~6,000 adult patients annually, identified key root causes of missed injuries, including lack of adherence to best practices. To address this, a validated trauma tertiary survey (TTS) was integrated into the EPIC EHR system to enhance injury detection and improve documentation. Interventions included mobilizing a multi-disciplinary team, conducting a literature review, analyzing trauma registry data, and designing a standardized, trackable survey. Approximately 150 residents were educated over the 15-week implementation period in Fall 2024. Results: The standardized TTS was successfully integrated into EPIC, increasing adherence to documentation from 0% to 65%. Of 25 new complaints recorded, only four (16%) were confirmed as actual injuries—significantly fewer than the previous year’s 42 missed injuries. Conclusions: Implementing the electronic TTS standardized trauma evaluations and improved documentation has shown to reduce missed injuries. If sustained, the projected annual missed injuries (13.9) represent a substantial reduction from 42 the prior year. These findings align with literature supporting the effectiveness of tertiary surveys. Future efforts will focus on clinician education, adherence reinforcement, and long-term integration through Advanced Practice Providers and faculty engagement.