Electronic Trauma Resuscitation Documentation and Decision Support Using T6 Health Systems Mobile Application: A Combat Trauma Center Pilot Program

BACKGROUND The care of trauma patients in combat operations is handwritten on a 5-page flow sheet. The process requires the manual scanning and uploading of paper documents to bridge the gap between electronic and paper record management. There is an urgent operational need for an information technology solution that will enable medics to better capture patient treatment information which will improve long term healthcare without impacting short term care responsibilities. METHODS Survey study of AAST members including detailed questions regarding demographics, clinical practice, family, lifestyle, and emotional support. Primary outcome was WLB while the secondary outcome was surgeon burnout. METHODS We conducted a process improvement project to evaluate the ability of T6 Health Systems Mobile Application to improve combat casualty care data collection at a deployed trauma hospital. We performed a head-to-head comparison of the completeness and accuracy of data capture of electronic versus handwritten records to determine non-inferiority. RESULTS Over the 90-day pilot there were 131 trauma evaluations of which 53 casualty resuscitations (40.5%) were also documented in the electronic application. We compared completeness and accuracy of admit, prehospital, primary survey, secondary survey, interventions, and trends data (Figure 1). We found an overall 13% increase in data capture at 96% accuracy compared to the written record suggesting the electronic record was superior. Completion of electronic documentation compared with paper by section was statistically significantly higher for Admitting Data 119.7% (p<0.0001), Prehospital 116.2% (p=0.0039), Primary 109.6% (p<0.001), and Secondary 125.5% (p<0.001). We also had the medical evacuation teams document prehospital and en route care then synchronize the record in the trauma bay, allowing the trauma teams there to continue documenting on the same casualty record, likely contributing to superiority since teams did not have to re-document based on an oral report (Figure 2). CONCLUSIONS Our pilot program in the deployed environment demonstrated a mobile technology that actually enhanced the completeness and accuracy of paper trauma documentation that has the capability of providing patient-specific decision support and real-time data analysis. LEVEL OF EVIDENCE Decision Analysis Study, Level III.