Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Resuscitation of critically injured patients requires effective team leadership. Poor communication is the leading cause of sentinel events. Closed-loop communication reduces error during trauma resuscitations. Nonetheless, previous studies show few verbal orders are audible. Verbal orders during trauma resuscitations have not been studied for completeness. In this project we aimed to assess whether verbal orders for medications and blood products during trauma resuscitations were complete, audible, and used closed-loop communication.

Methods: This was an observational assessment of a convenience sample of verbal orders that trauma captains gave for medications and blood products during the primary and secondary survey. It was conducted in an academic emergency department (ED) at an adult Level 1 trauma center. We assessed medication orders for the presence or absence of medication name, dose, and route. Blood orders were evaluated for the presence or absence of blood product (packed cells or whole blood) and type (O- or O+). We recorded orders as audible or inaudible. Closed-loop communication was recorded as present or absent. Orders were considered complete if they included all elements. We used descriptive statistics to analyze data.

Results: There were 186 verbal orders enrolled: 165 (88.7%) for medications and 21 (11.3% for blood products. For medication verbal orders, 77.9% (n=127) were audible, 73.6% (n=120) included the name, 62.0% (n=101) included the dose, 17.8% (n=29) included the route, and 73.5% (n=111) used closed-loop communication. Overall, 23 (14.1%) medication verbal orders were complete. Regarding verbal orders for blood, 16 (76.2%) were audible, three (14.3%) included the blood product, seven (33.3%) included the blood type, and 13 (61.9%) used closed-loop communication. Overall, 0% (n=0) of the blood product verbal orders were complete.

Conclusion: Audible, complete verbal orders, and closed-loop communication were underused during trauma resuscitations. Interventions to improve communication of verbal orders warrant evaluation in the ED.