Table 2 Components of the major trauma case peer review tool
Basic information | |
Record ID | This is the unique record used by the study team to identify each record |
Reviewer ID | Each reviewer has a unique identification number |
Date of review | For recording when the review was conducted |
Date and time of injury | Key time variables allow for the development of a chronology |
Age and gender | Age and gender to allow comparative analysis across groupings and determination of specific areas for education/change within the trauma system that considers age related physiology, age specific injury patterns [36, 37] |
Date and time of incident(s) | Key time variables allow for the development of a chronology |
Section 1: Patient factors | |
Background | Such as whether the child is Aboriginal or Torres Strait Islander, culturally and linguistically diverse or a refugee to assist with the identification of potentially vulnerable groups and engagement with appropriate stakeholders when required |
Previous location and source of referral | Primary presentation, secondary presentation (e.g. inter-hospital transfer) and source of referral (e.g. self, road ambulance) to assist with mapping of patient flow and identification of potential areas of deficits |
Other patient factors | This component attempts to capture the unique characteristics of the patient in the context of their presentation including: complexity and acuity of presentation; behavioural and social factors |
Section 2: Presenting problem/diagnosis | |
Injury mechanism, injuries, and signs and symptoms on presentation | These sections capture the cause and nature of the injury |
Section 3: Timeline of events | |
Timeline of events | Timeline of events in chronological order |
Section 4: General incident information | |
Did the patient die? | To determine whether the child died as a result of their injuries and to assist with further questioning |
Phase of care the patient died in (pre-hospital/during transport/in-hospital/which ward?) | To provide a construct on where the incident occurred, allowing monitoring of one point of care or service |
Was a toxicology screen/post mortem conducted? If yes, what type was completed and is the report available? | Autopsy reports are a valuable source of information and provide an important adjunct to any investigation of factors potentially contributing to patient mortality [8] |
Category of the problem (either clinical, systems or communication) | To assist with the determination of how the clinical deficit occurred and to allow comparative analysis across groupings and determination of specific areas for education/change within the trauma system [27] |
Section 5: Specific services involved in the care delivery problem | |
Specific department and staff involved in the care delivery problem | This multiple choice and free text response section allows for determination of services involved in the care delivery problem |
Section 6: Factors contributing to the care delivery problem | |
Equipment | Including: lack of medical equipment, medical equipment breakage or failure, equipment failure (design), medical equipment not elsewhere classified, non-medical equipment and medical supplies |
Work environment | Including: light, temperature, noise, physical layout, security and work environment not elsewhere classified |
Staff action | Including: verbal communication and written documentation issues, medical task failure, monitoring, delay, misdiagnosis, medication issue and human factors not elsewhere classified |
Patient | Including: physical health, health state, communication issues, medication, toxicology, clothing, and patient characteristics not elsewhere classified |
Organisational factors | Including: work practices, policies or guidelines, supervision, organisational resources, work pressure and organisational factors not elsewhere classified |
Individual factors | Including: training, experience, fatigue, stress and individual factors not elsewhere classified |
Other factors | This is a free text response for factors the reviewer feels are not addressed in the previous categories |
Section 7: Outcome | |
Best description of the incident | How the incident can be best described ranging from clinically preventable to clinically non-preventable death, near miss of death, near miss of incident that did not result in death, preventable error causing lasting disability or no problems identified |
Section 8: Positives of care | |
Positive aspects of care the patient received | This free text response allow for the recording of positives of care the patient received |
Section 9: Prior knowledge | |
Reviewer prior knowledge of the case | Included to identify whether the reviewer had prior knowledge of the case which may affect their review of the case |
Section 10: Panel discussion | |
Summary of review and recommendations | Free text response to allow for a summary of the review and recommendation for corrective strategies after panel discussion |
Interview of staff involved? | To allow staff details to be recorded if staff are recommended for interview to obtain further information for completing the assessment |