354 - Can You Make the Cut? An Operating Room’s Journey to Mass Casualty Preparedness
Clinical Issue: Mass casualty incidents (MCIs) are on the rise in the United States. As such, all hospitals, particularly Level I Trauma Centers, need to have a MCI response plan.Description of team: Multidisciplinary team: Operating Room (OR) Director, Trauma Coordinator, Manager Sterile Supply, staff (Anesthesia, OR, and Supply)Prep and Planning: Mass casualty incidents (MCIs) are on the rise in the United States. As such, all hospitals, particularly Level I Trauma Centers, need to have a MCI response plan. The OR specifically needs to have a process for managing multiple trauma patients presenting to the department in a MCI. We began to work with the Summa Health System – Akron Campus MCI drill design team (MDDT), which had not penetrated to the OR. However, the OR role was identified as paramount to a robust MCI response plan if multiple injured patients were to present at the Level I Trauma Center.
Assessment: After several MCI simulated drills (MSDs), we identified three major gaps and created action items to address each, which included the development of: 1) rapid communication to notify staff of an event, 2) quick access to damage control supplies for multiple patients, and 3) Charge Nurse MCI protocol. Implementation: OR staff became involved in MCI notification system (i.e., added to the notification list, received access to send MCI page, and potential need for staff to report), the Supply Team Manager identified supplies for quick pull MCI cards, and Charge Nurse MCI protocol (i.e., instructions on sending MCI page, available MCI cards, and collaborating with Anesthesia) was developed. Education related to MCI notification system and MCI cards was developed and shared with all staff during an in-service and added to new employee orientation. Two surveys were created: 1) staff survey (measuring self-efficacy and teamwork) provided to staff involved in MSDs post-drill and 2) department survey (measuring specific tasks for OR and Anesthesia) provided to staff every six months. Outcomes: After developing a MCI process the OR fully prepared (i.e., supplies and staff) 8 cases in 13 minutes. The staff surveys resulted in statistically significant differences on the teamwork measurement between different departments (p<0.001) with the Anesthesia department reporting higher averages than three other departments using a protected Least Significant Difference (LSD) procedure. There were statistically significant differences (p=0.010) on the general drill subscale of the department survey from time one to time two using a t-test comparison.Implications for nursing staff: Continued engagement with the MDDT and MSDs in the OR keep our staff prepared. Education on the OR MCI process is provided to new hires and all staff review via biannual in-service. Results demonstrate the increase in staff perceived teamwork and department preparedness. Additionally, changes in OR process (i.e., communication, case cards, and protocol) demonstrated decreased time required for OR suite preparedness, which is a crucial and limited resource for MCIs. While this process is specific to Summa Health System, it may provide a foundation for any organization seeking resources to increase preparedness for MCIs.
Co-Authors: Randy Bigler, Nicole Hamilton, Mary Moran