Patient Experience Lab: Trauma Bay Team Dives In

“It’s like CPR, but a bit more sophisticated.”

Dr. Nathan Siegel, a progenitor of this project, is a big framed, 39 year old emergency medical physician. He studied Anthropology at SUNY-Buffalo then decided to come to medicine only after he graduated. He spent a few years getting his post-Bac requirements done, then went to Yale Medical School. He did his residency in Emergency Medicine at the University of Michigan Hospital, then came to Rhode Island late last year. On Monday afternoon, he gave the design team a guided tour through “Resuscitation Bay 101.”

A resuscitation bay, Dr. Siegel laid out, is like an exam room, but “it’s larger and it has more stuff.” But though a physician can execute some “extreme interventions,” it’s not an Operating Room either. The focus is on information gathering and speed. The patients that go to an RB are unstable or potentially unstable, but sometimes are awake and communicating.

There’s a great deal of variability regarding RB design and implementation across the country and the world, for that matter, and RIH has a rather unique setup: 6 “critical care” rooms, with two bays per room. There are two “urgent areas,” where patients requiring less intense care are placed.

Dr. Siegel took the team through the different historical disciplines and philosophical divisions within the medical field, generally (medical intervention v. trauma intervention, medicine v. surgery, etc.), and their importance to the operation and training of an ED. He then gave a brief discussion of the ABC’s of emergency medicine (Airway, Breathing, Circulation), and described the invasive and non-invasive procedures that are routinely done in an RB.

Given the importance of the information gathering process, we had a brief discussion of the data gathering and documentation process, the format (digital, paper, mental) of that data.

Perspectives and Problems

We then heard from A.D., an extremely proficient and very experienced ED/Trauma Nurse. She led us through the process of treating patients in an RB from her perspective, and noted her top problems, to which Dr. Siegel chimed in, on occasion.

Their chief problem, bar none, was communication, from Nurse A.D.'s perspective. They’d tried these little “Star Trek”-like devices, they’d tried Nextel phones and a system of text messages, which worked great for a short period of time, but succumbed, eventually, to the rigors of the ED environment: things break, they fall, the batteries die, etc. So they’d gone back to using a very loud intercom system via boxes on the walls. This was quite public, the secretaries they talked to quite excitable.

Nurse A.D. and Dr. Siegel then went through the different devices in the room, how they worked, what their problems were, etc. and then discussed different special scenarios that required special protocols. The most important of these, which will be discussed further in a future dispatch, is called a “Max Team,” where sometimes more than 15 people with special roles can come running into a room to provide treatment and consultation.

Getting It Together

The design team spent the rest of the week scheduling the observation rounds, dividing and specializing the research areas among individual members, and then starting that research. I had time to do a fascinating series of one-on-one interviews with the team members, their backgrounds and their thoughts on the project thus far, which we’ll hopefully roll out as a podcast somewhere down the line.

It’s worth noting that already the design team and, from what I can gleam, Dr. Siegel and the ED nurses in the know are all quite excited over the novel nature of this collaboration. There is a palpable optimism and, on the part of the design team especially, a belief that this project will yield real, tangible, long-term improvements to the quality of care delivered in an RB.

Next week the focus will be on continuing the background research, getting the focus groups together, and starting to analyze initial data from the observation rounds.

I’ll be here to tell you how it goes.

Posted July 20, 2007 10:29 PM by Allan Tear | Permalink