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Friday, April 11, 2014
Future emergency room
California doctors work to speed up trauma care

Before the patient reached the emergency room, doctors, residents and nurses at California's Cedars-Sinai Medical Center knew what to expect by glancing at their smartphones. The details came in via text messages: A 35-year-old man had driven head-on into a bus. He had suffered major chest injuries. His vital signs were crashing.

This was not just another day in the hospital. It involved a dummy in a laboratory billed as the "O.R. of the future." In reality, trauma care is rarely this organized. But doctors are learning that when it comes to treating trauma patients, communication and coordination can determine whether someone lives or dies.

At the lab, doctors are experimenting with a range of new techniques and technologies. At the heart of the lab is a room that can be outfitted as an ER, operating room or intensive care unit — depending on the practice of the day. The research strives to speed up trauma care by eliminating workflow disruptions and honing communication skills.

Nurse Anna Doyle is used to working with doctors who parachute into the latest crisis. It's often a chaotic scene, and not everyone takes the time to get to know one another. During a recent rehearsal, a resident piped up and asked for everyone's names. Doyle said she found the introductions calming — even if it was just practice. "We had a personal moment ... that never happens," she said.

Before the lab opened, surgeon-in-chief Dr. Bruce Gewertz and his colleagues followed real trauma patients from the moment they were unloaded from the ambulance to their transfer to the intensive care unit. Along the way, the team documented obstacles that slowed down care: Too many people spoke at the same time. A patient went for a CT scan only to find another patient already in the scanner. A resident's cellphone rang while scrubbing in.

Most of the time, researchers found, delays in care were caused by a lack of communication. The goal is to get everyone on the same page during the "golden hour," a concept borrowed from military medicine indicating that the first hour after a traumatic injury is the most vital in terms of preventing death. The team recently partnered with a consulting firm to develop an iPhone app that displays a patient's vitals and blasts out the information to the trauma team as members are assembling. There's also a text-messaging feature that allows doctors and nurses to communicate with one another before the patient arrives. It is hoped that these advances can dramatically improve the efficiency of trauma care.

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