Skip to main content
SpringerLink
Log in

Critical incident reporting systems (CIRS) in trauma patients may identify common quality problems

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Critical incident reporting systems (CIRS) are considered to be a valid instrument to identify typical errors in various clinical settings as well as in prehospital emergency medicine. Our aim was to review incidents and errors in the care of trauma patients during the period of emergency trauma room treatment before their transfer to the intensive care unit or the operation room.

Methods

We screened six open access and German language-based CIRS-platforms on the internet.

Results

We identified 78 critical incidents. They could be divided into four groups: organization related (n = 30), communication related (n = 6), equipment related (n = 28), and medical error (n = 23). Within the category, typical, common, or frequent clusters were identified, such as incomplete trauma team, malfunctioning equipment, or a lack of communication skills. In 12 cases (15.4%), patients were reported to have been harmed, mostly by medical errors. Three reported incidents (3.6%) were considered near-incidents.

Conclusions

Our results demonstrate that using CIRS is able to reveal individual or rare errors and allows for the identification of systematic errors and deficiencies in the acute care of trauma patients in the trauma room. This may guide quality control and quality improvement measures to be focused on the most common fields of demand.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hohenstein C, Hempel D, Schultheis K, Lotter O, Fleischmann T. Critical incident reporting in emergency medicine: results of the prehospital reports. Emerg Med J. 2014;31(5):415–8. https://doi.org/10.1136/emermed-2012-201871.

    Article  PubMed  Google Scholar 

  2. World Alliance for Patient Safety. WHO draft guidelines for adverse event reporting and learning systems. 2005. https://apps.who.int/iris/bitstream/handle/10665/69797/WHO-EIP-SPO-QPS-05.3-eng.pdf?sequence=1&isAllowed=y. Accessed 4 May 2018.

  3. Hansen K, Schultz T, Crock C, Deakin A, Runciman W, Gosbell A. The Emergency Medicine Events Register: an analysis of the first 150 incidents entered into a novel, online incident reporting registry. Emerg Med Australas. 2016;28(5):544–50.

    Article  Google Scholar 

  4. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324(6):370–6. https://doi.org/10.1056/nejm199102073240604.

    Article  CAS  PubMed  Google Scholar 

  5. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. 1991. Qual Saf Health Care. 2004;13(2):145–51 (discussion 51–2).

    Article  CAS  Google Scholar 

  6. Pucher PH, Aggarwal R, Twaij A, Batrick N, Jenkins M, Darzi A. Identifying and addressing preventable process errors in trauma care. World J Surg. 2013;37(4):752–8. https://doi.org/10.1007/s00268-013-1917-9.

    Article  PubMed  Google Scholar 

  7. Wolff AM. Detecting and reducing adverse events in an Australian rural base hospital emergency department using medical record screening and review. Emerg Med J. 2002;19(1):35–40.

    Article  CAS  Google Scholar 

  8. Trentzsch H, Imach S, Kohlmann T, Urban B, Lazarovici L, Pruckner S. Better apprehension of errors in the early clinical treatment of the severely injured. Unfallchirurg. 2015;118(8):675–85. https://doi.org/10.1007/s00113-015-0029-4.

    Article  CAS  PubMed  Google Scholar 

  9. Major trauma: service delivery. NICE National Institute for Health and Care Excellence. 2016. https://www.nice.org.uk/guidance/NG40/chapter/Recommendations#organisation-of-hospital-major-trauma-services. Accessed 4 May 2018.

  10. Frink M, Lechler P, Debus F, Ruchholtz S. Multiple trauma and emergency room management. Dtsch Arztebl Int. 2017;114(29–30):497–503. https://doi.org/10.3238/arztebl.2017.0497.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rotondo MCC, Smith R. Resources for optimal care of the injured patient. Chicago: American College of Surgeons; 2014.

    Google Scholar 

  12. Quality Indicators for Trauma Outcome and Performance. The trauma audit & research network. 2010. https://www.tarn.ac.uk/content/downloads/27/Quality%20Indicators_26-02-10.pdf. Accessed 6 May 2018.

  13. Parmentier-Decrucq E, Poissy J, Favory R, Nseir S, Onimus T, Guerry MJ, et al. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors. Ann Intensive Care. 2013;3(1):10. https://doi.org/10.1186/2110-5820-3-10.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Jia L, Wang H, Gao Y, Liu H, Yu K. High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective, multicenter study in China. Crit Care. 2016;20:12. https://doi.org/10.1186/s13054-016-1183-y.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Missbach-Kroll A, Nussbaumer P, Kuenz M, Sommer C, Furrer M. First experience with a critical incident reporting system in surgery. Chirurg. 2005;76(9):868–74. https://doi.org/10.1007/s00104-005-1034-x(discussion 75).

    Article  CAS  PubMed  Google Scholar 

  16. Zakrison TL, Rosenbloom B, McFarlan A, Jovicic A, Soklaridis S, Allen C, et al. Lost information during the handover of critically injured trauma patients: a mixed-methods study. BMJ Qual Saf. 2016;25(12):929–36. https://doi.org/10.1136/bmjqs-2014-003903.

    Article  PubMed  Google Scholar 

  17. Deutsche Gesellschaft für Unfallchirurgie. Weißbuch Schwerverletzten-Versorgung. Stuttgart. 2012.

  18. Lawton R, Parker D. Barriers to incident reporting in a healthcare system. Qual Saf Health Care. 2002;11(1):15–8.

    Article  CAS  Google Scholar 

  19. Macrae C. The problem with incident reporting. BMJ Qual Saf. 2016;25(2):71–5. https://doi.org/10.1136/bmjqs-2015-004732.

    Article  PubMed  Google Scholar 

  20. Boyle MJ. Comparison overview of prehospital errors involving road traffic fatalities in Victoria, Australia. Prehosp Disaster Med. 2009;24(3):254–61.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Ms. Katherine Noelle Brooks (University of Seattle, 550 17th Ave, 98122 Seattle, WA, USA) for language revision.

Author information

Authors and Affiliations

  1. Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany

    Matthias Niemeier, Uwe Hamsen, Emre Yilmaz, Thomas A. Schildhauer & Christian Waydhas

  2. Swedish Neuroscience Institute, Swedish Medical Center, Seattle, 550 17th Ave, Seattle, WA, 98122, USA

    Emre Yilmaz

  3. Medizinische Fakultät der Universität Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany

    Christian Waydhas

Authors
  1. Matthias Niemeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Uwe Hamsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emre Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas A. Schildhauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian Waydhas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthias Niemeier.

Ethics declarations

Conflict of interest

Matthias Niemeier, Uwe Hamsen, Emre Yilmaz, Thomas Armin Schildhauer and Christian Waydhas declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 29 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Niemeier, M., Hamsen, U., Yilmaz, E. et al. Critical incident reporting systems (CIRS) in trauma patients may identify common quality problems. Eur J Trauma Emerg Surg 47, 445–452 (2021). https://doi.org/10.1007/s00068-019-01128-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-019-01128-y

Keywords

Search

Navigation