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General Surgeons and trauma. A questionnaire survey of General Surgeons training in ATLS and involvement in the trauma team
Abstract
To determine the level of training of General Surgeons in the UK in the Advanced Trauma Life Support (ATLS) course and their involvement with hospital trauma teams.
Postal questionnaire sent to General Surgical Consultants and Higher Surgical Trainees (HSTs).
58% of General Surgeons who responded had attended ATLS, but only 30% of those who had been Consultants for more than 10 years. Eighty-seven percent considered the course 'essential' or 'some value'. Sixty-one percent of hospitals represented had a trauma team. A Consultant General Surgeon was a member of the team in 50% and the General Surgical HST in 82%.
ATLS has been widely accepted by General Surgical Trainees and recently appointed Consultants. The trauma team approach to resuscitation has yet to become fully established in the UK and there is limited input from Consultant General Surgeons.
... Our data has indicated the positive effect of a standardized training (ATLS ® ) on the quality assessment of multiple-trauma management within the specialities. The evidence that ATLS ® courses have resulted in improved patient outcome is still debated [1,4,24]. Although our results support instituting a standardized high-quality training programme [25] they are based on only 45 anaesthetists and surgeons in one hospital. ...
Einleitung Wir untersuchten, ob die Mitarbeiterbefragung in der Qualitätskontrolle des Schockraum-Managements von Nutzen sein kann. Methode Konsekutive anonyme schriftliche Befragung (15 Fragen, Likert-Skala 1–5) der klinisch Mitarbeitenden aller Schockraumeinsätze mit Verdacht auf Mehrfachverletzung von Juli 2002 bis Dezember 2003 (Anova; p Ergebnisse Bei 171 unfallchirurgischen Einsätzen retournierten 884 Beteiligte den Antwortbogen. Die Beobachtungen der Mitarbeitenden hingen signifikant von der jeweiligen Schockraumsituation ab. Am meisten kritisiert wurden das Zeitmanagement und die eigene Ausbildung (Likert-Skala ®-Kurs absolviert (p Schlussfolgerung Unser Fragebogen erwies sich als gut diskriminierendes Instrument und kann somit die Erfassung klinischer Parameter im Qualitätsmanagement der Schockraumphase sinnvoll ergänzen. Vor einer breiteren Anwendung werden allerdings zusätzliche Validierungs- und Korrelationsuntersuchungen benötigt.
... Our data has indicated the positive effect of a standardized training (ATLS ® ) on the quality assessment of multiple-trauma management within the specialities. The evidence that ATLS ® courses have resulted in improved patient outcome is still debated [1,4,24]. Although our results support instituting a standardized high-quality training programme [25] they are based on only 45 anaesthetists and surgeons in one hospital. ...
Background and objective, Staff attitude plays a pivotal role in quality management. The objective of the present study was to further define how interdisciplinary emergency hospital staff experience their daily work and the extent to which the professional speciality and training of an individual influences his/her assessment of multiple-trauma team performance. Methods: The clinical staff involved in multiple-trauma emergency management of a university hospital was asked to answer a confidential questionnaire. Factorial analysis was used to identify 8 major dimensions from a total of 53 items. Results: The questionnaire was returned by 128 team members. All professional groups were most dissatisfied with the dimensions 'education and training', 'work sequence between specialities' and 'communication between specialities'. Assessment of the quality of in-hospital emergency-trauma management differed significantly between professional specialities (ANOVA, F = 5.2; P = 0.028); surgeons gave the highest ratings for all but one dimension. Having taken an Advanced Trauma Life Support (ATLS (R)) course influenced significantly the total rating of multiple-trauma treatments of anaesthetists and surgeons (F = 5.5; P = 0.024). Conclusions: The perceptions of interdisciplinary trauma team members without the completion of an ATLS (R) training course were that they did not communicate enough with each other and that there were differences between their expectations and reality. The differences and the communication deficits were overcome in team members who had passed an ATLS (R) course.
... Our data has indicated the positive effect of a standardized training (ATLS ® ) on the quality assessment of multiple-trauma management within the specialities. The evidence that ATLS ® courses have resulted in improved patient outcome is still debated [1,4,24]. Although our results support instituting a standardized high-quality training programme [25] they are based on only 45 anaesthetists and surgeons in one hospital. ...
Staff attitude plays a pivotal role in quality management. The objective of the present study was to further define how interdisciplinary emergency hospital staff experience their daily work and the extent to which the professional speciality and training of an individual influences his/her assessment of multiple-trauma team performance.
The clinical staff involved in multiple-trauma emergency management of a university hospital was asked to answer a confidential questionnaire. Factorial analysis was used to identify 8 major dimensions from a total of 53 items.
The questionnaire was returned by 128 team members. All professional groups were most dissatisfied with the dimensions 'education and training', 'work sequence between specialities' and 'communication between specialities'. Assessment of the quality of in-hospital emergency-trauma management differed significantly between professional specialities (ANOVA, F=5.2; P=0.028); surgeons gave the highest ratings for all but one dimension. Having taken an Advanced Trauma Life Support (ATLS) course influenced significantly the total rating of multiple-trauma treatments of anaesthetists and surgeons (F=5.5; P=0.024).
The perceptions of interdisciplinary trauma team members without the completion of an ATLS training course were that they did not communicate enough with each other and that there were differences between their expectations and reality. The differences and the communication deficits were overcome in team members who had passed an ATLS course.
... The training and experience requirement is in direct contrast to the limited opportuni- ties that currently exist within the NHS, 2 and is compound- ed by current training programmes and subspecialistion within general surgery.I nm any UK institutions, general surgeons are not involved in the initial trauma team or resuscitation of the casualty. 3 The limitation of trauma exposure in the UK is evident from previous studies which demonstrated that nearly half of trainees will not be involvedi nt he surgical management of liver injury,2 0% will not undertake at rauma splenectomy and only aq uarter will see at rauma thoracotomy during the whole of their surgi- cal training. These data from contemporary experience on Operation HERRICK support the development of at raining post for military general surgical trainees under the direct one-to- one supervision of aconsultant general surgeon. ...
In the UK, general surgical specialist trainees have limited exposure to general surgical trauma. Previous work has shown that trainees are involved in only two blunt and one penetrating trauma laparotomies per annum. During their training, nearly half of trainees will not be involved in the surgical management of liver injury, 20% will not undertake a trauma splenectomy and only a quarter will see a trauma thoracotomy. Military general surgical trainees require training in, and exposure to, the surgical management of trauma and specifically military wounding patterns that is not available in the UK. The objective of this study was to determine whether operative workload in the sole British surgical unit in Helmand Province, Afghanistan (Operation HERRICK) would provide a training opportunity for military general surgical trainees.
A retrospective theatre log-book review of all surgical cases performed at the Role 2 (Enhanced) treatment facility at Camp Bastion, Helmand Province on Operation HERRICK between October 2006 and October 2007, inclusive. Operative cases were analysed for general surgical trauma, laparotomy, thoracotomy, vascular trauma and specific organ injury management where available.
A total of 968 operative cases were performed during the study period. General surgical procedures included 51 laparotomies, 17 thoracotomies and 11 vascular repairs. There were a further 70 debridements of general surgical wounds. Specific organ management included five cases of liver packing for trauma, five trauma splenectomies and four nephrectomies.
A training opportunity currently exists on Operation HERRICK for military general surgical specialist trainees. If the tempo of the last 12 months is maintained, a 2-month deployment would essentially provide trainees with the equivalent trauma surgery experience to the whole of their surgical training in the UK NHS. Trainees would gain experience in military trauma as well as specific organ injury management.
Introduction
Training in major trauma management is increasingly important in our country and throughout the world in general, but there is great uncertainty about who treats these patients in our countryand how do surgical residents obtain experience in evaluation, diagnosis and treatment of these patients.
Objective
To find out, from surgery residents, the current state of their training and knowledge of major trauma patient care in our country, and their opinions on how to improve it. At the same time, to analyse whether major trauma patient care in our hospitals has changed in recent years, along with the factors that may influence teaching in how to manage these patients.
Material and method
A survey was sent with a prepaid envelope to 78 university hospitals accredited for resident training, during the period from March to October 2005.
Results
When comparing traditional care of major trauma patients with that of the last 5 years there were no statistically significant differences (p = 0.77). The fact that the hospital is a referral centre for trauma care of trauma does not significantly affect whether the resident feels well-trained (p = 0.7), or well-informed (p = 0.33).
Conclusions
General surgery residents do not feel well-trained or well-informed on the management of major trauma patients despite working in hospitals that treat these patients and an increasing number of surgeons are involved in the trauma. There are few lines of research into multiple trauma, despite the linkage with university centres.
To evaluate the use of protocol-driven trauma resuscitation strategies in UK emergency departments.
Postal/internet questionnaire survey of emergency departments to evaluate the existence of guidelines or protocols to direct resuscitation, blood component treatment, second line imaging of patients who had major trauma and the existence of a trauma team/trauma call system.
243 departments were identified and contacted, 183 responded. Five replies were excluded. Of the remaining 178 departments, 139 (78.1%) had a trauma team or trauma call system, but only 49 (27.5%) had a guideline or protocol for resuscitation. 92 (51.7%) had guidelines or protocols for blood component treatment in trauma, and 88 (49.4%) had guidelines or protocols for the use of second line imaging in trauma. The use of protocols and guidelines did not correlate with emergency department size, as measured by volume of activity.
The utilisation of trauma resuscitation protocols and guidelines in British emergency departments is limited. Given the clear benefits of these strategies, consideration should be given to greater integration of such algorithms into practice.
The origins, development, and success of the ATLS course are described with reference to the literature.
The purpose of this study was to examine whether staff questionnaire evaluation is useful for quality control in the emergency room (ER) setting.
Consecutive anonymous questionnaires (Likert scale 1-5) were filled out by the involved medical staff in all ER trauma cases in a university hospital from July 2002 to December 2003 (analysis of variance, P<0.05).
In 171 ER cases, 844 staff members responded. Main criticisms concerned time management or satisfaction with personal ER training (Likert <4). Consultants rated the quality of their training significantly higher than younger doctors, two thirds of consultants vs one third of residents having passed an Advanced Trauma and Life Support course (P<0.001). Depending on responders' professional specialties and whether the situation concerned multiple trauma (Injury Severity Score >15), a significant systematic difference resulted.
Our standardized staff questionnaire evaluation was revealed to be a discriminative instrument for quality management of trauma cases in the ER. To confirm these findings, correlation with clinical outcome data and further validation of the method are needed.
Time to definitive trauma care directly influences patient survival. Patient transport (retrieval) services are essential for the transportation of remotely located trauma patients to a major trauma centre. Trauma surgical expertise can potentially be combined with the usual retrieval response (surgically supported response) and delivered to the patient before patient transportation. We identified the frequency and circumstances of such surgically supported retrievals.
Retrospective review of trauma patients transported by the NRMA CareFlight, New South Wales Medical Retrieval Service, Australia, from 1999 to 2003, identifying patients who had a surgically supported retrieval response and an urgent surgical procedure carried out before patient transportation to an major trauma centre.
Seven hundred and forty-nine trauma interhospital patient transfers were identified of which 511 (68%) were categorized as urgent and 64% of which were rural based. Three (0.4%) patients had a surgically supported retrieval response and had an urgent surgical procedure carried out before patient transportation. All patients benefited from that early surgical intervention.
A surgically supported retrieval response allows for the more timely delivery of urgent surgical care. Patients can potentially benefit from such a response. There are, however, important operational considerations in providing a surgically supported retrieval response.
Advanced trauma life support (ATLS) has become a desirable or even essential part of training for many surgeons and anaesthetists, but aspects of the ATLS course have attracted criticism. In the absence of published data on the views of trainees, this study sought their opinions in a structured questionnaire, which was completed by trainees in accident and emergency (A & E) (26), anaesthetic (82), general surgical (26), orthopaedic (42) and other (5) posts in different hospitals (response rate 66%). Of the trainees, 78% had done an ATLS course and, of these, 83% considered ATLS a 'major advantage' or 'essential' for practising their proposed specialty--100% for A & E, 94% for orthopaedics, 92% for general surgery, and 75% for anaesthetics. ATLS was considered a major curriculum vitae (CV) advantage by 94%, 85%, 50%, and 45%, respectively. Over 90% had positive attitudes towards ATLS, and 74% selected 'genuine improvement of management of trauma patients' as the most important reason for doing the course: 93% thought ATLS saved lives. Of the respondents, 83% thought that all existing consultants dealing with trauma patients should have done the course, and 41% thought it offered major advantages to doctors not involved in trauma. Funding problems for ATLS courses had been experienced by 14% trainees. This survey has shown that most trainees view ATLS positively. They believe that it provides genuine practical benefit for patients, and very few regard ATLS primarily as a career advantage or mandate.
An analysis of the number of trauma teams and the extent of involvement of basic surgical trainees in these teams in the South-West region is presented.