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This study aims to examine trauma room staff’s perception of factors that influence workflow in trauma care from a physical environment standpoint.

A semi-structured focus group method was used. Trauma team members, representative of various roles within a team, were recruited from five Level I trauma centers in the USA, through a convenience sampling method. A total of 53 participants were recruited to participate in online focus groups. The Systems Engineering Initiative for Patient Safety model was used to analyze the findings.

In addition to factors directly related to the physical environment, aspects of people and technology, such as crowding and access to technology, were found to be related to the physical environment. Examples of factors that improve or hinder workflow are layout design, appropriate room size, doors, sink locations, access to resources such as X-ray or blood and access to technology. Seamless and uninterrupted workflow is crucial in achieving efficient and safe care in the time-pressured environments of trauma rooms. To support workflow, the physical environment can offer solutions through effective layout design, thoughtful location of resources and technology and room size.

Trauma rooms are time-pressured and complex environments where seconds matter to save a patient’s life. Ensuring safe and efficient care requires seamless workflow. However, the literature on workflow in trauma rooms is limited.

Earlier studies have identified artefacts, but have only to a lesser degree looked at their effects. The purpose of this paper is to investigate how artefacts contribute to organisation.

A trauma team at a university hospital has been observed and its members interviewed.

The trauma team showed itself to be rich on artefacts since it had strong internal driving forces, high legitimacy, and tried to live up to high expectations from the outside. Its members were motivated to be in the forefront of trauma care. Through renewal, the team succeeded in maintaining demarcation. It also succeeded in systemising internal work tasks and made for itself a position in relation to the outside. The team's capacity, however, came to be limited by internal conflicts and battles for prestige.

The study shows that informal logic has a strong influence on teams. Teamwork contributed to the development of organisational structure and motivation for the personnel.

Earlier studies advocate the important role of artefacts in order to communicate, collaborate, negotiate or coordinate activities. The conclusion is that artefacts also have an organising and developing effect on teams in a fragmented and differentiated healthcare.

Facilitated by a decision support system tool, the purpose of this paper is to find the “best” allocated number of surgeons and medicine doctors that reduce patients' non‐value‐added time (NVAT) and total time in the system (TTS).

Interview and observation are first conducted in order to get general insights about (and to understand) the emergency ward of Sahlgrenska Hospital in Gothenburg (Sweden) and its value stream (flow). Then, time‐related data are collected by conducting time measurements empirically and through the triage database. The statistics of the collected empirical data represent the initial state of the system and are utilised as the input of ARENA^® simulation. A simulation scenario is designed by constructing a 3×3 table (= nine combinations) that contains a varying number of surgeons and medicine doctors allocated in the emergency ward. For each combination, 1,000 replications apply (=10 runs @ 100 replications). “Runs” are the cycles or how many times the simulation is executed, while “replications” refer to how many times a computer (automatically) repeats the simulation in a single execution. The simulation length of a single replication was set at 24 hours due to the fact that an emergency ward was always open. The selected feasible solution is the “best” combination of surgeons and medicine doctors that reduces the existing NVAT and TTS while ensuring that the resource utilisation is at a “reasonable” level (and did not exceed 100 per cent).

The simulation output indicates that the emergency ward may achieve considerable reduction in a patients' NVAT and total patients' time in the system by assigning three medicine doctors and three surgeons. This combination leads to (in average) 13 per cent reduction of NVAT while maintaining the TTS at approximately the same level.

An expanded simulation model with a higher level of complexity and ability to accommodate, e.g. cost of care, flow/layout reconfiguration would be greatly needed and is of interest. It would also be relevant to add greater flexibility by assigning more parameters in the simulation model (other than medicine doctor and surgeon).

Simulation can be considered as a valuable decision‐support tool in the adoption of lean in healthcare due to its flexibility in the sense that it is able to show the output (outcome) of various scenarios before any actual change is made. The results of our study present another side of the adoption of lean thinking besides layoff.

To explore the perceptions of surgical team members in a tertiary hospital in Jordan toward the factors influencing patient safety culture (PSC).

This was a qualitative descriptive study intended to characterize the factors that influence PSC. Interviews were conducted with health-care providers in the operation room (OR) in a tertiary Jordanian hospital. Participants included surgeons, anesthetists, nurses and senior surgical residents who had worked for three years minimum in the OR. Thematic analysis was used to analyze the data.

A total of 33 interviews were conducted. Thematic analysis of the content yielded four major themes: (1) operational factors, (2) organizational factors, (3) health-care professionals factors and (4) patient factors. The respondents emphasized the role of the physical layout of the OR, implementing new techniques and new equipment, and management support to establish a safety culture in the operating room setting.

The present research study will have implications for hospitals and health-care providers in Jordan for developing organizational strategies to eliminate or decrease the occurrence of adverse events and improve patient safety in the OR.

This study aims to investigate how trauma team members perceive technological equipment and tools in the trauma room (TR) environment and to identify how the technological equipment could be optimized in relation to the TR’s space.

A total of 21 focus group sessions were conducted with 69 trauma team members, all of whom worked in Level I TRs from six teaching hospitals in the USA.

The collected data was analyzed and categorized into three parent themes: imaging equipment, assistive devices and room features. The results of the study suggest that trauma team members place high importance on the availability and versatility of the technological equipment in the TR environment. Although CT scans are a usual procedure necessity in TRs, few facilities were optimized for easy access to CT-scanners for the TR. The implementation of cameras and screens was suggested as an improvement to accommodate situational awareness. Rapid sharing of data, such as imaging results, was highly sought after. Unorthodox approaches, such as the use of automatic doors, were associated with slowing down the course of actions.

This study provides health-care designers with the knowledge they need to make informed decisions when designing TRs. It will cover key considerations such as room layout, equipment selection, lighting and controls. Implementing the strategies will help minimize negative patient outcomes.

Level I TRs are a critical element of emergency departments and designing them correctly can significantly impact patient outcomes. However, designing a TR can be a complex process that requires careful consideration of various factors, including patient safety, workflow efficiency, equipment placement and infection control. This study suggests multiple considerations when designing TRs.

This study aims to discover how leadership emerges in a hospital’s trauma team in a simulated trauma care situation. Instead of investigating leadership from a leader-centric perspective, or using a metrics-based approach to reach generalizable results, the study aims to draw from post-heroic theories by applying leadership-as-practice and sociomaterial perspectives that emphasize the cultural-historical context and emergent nature of leadership.

The study was conducted in a Finnish central hospital through ethnographic observations of 14 in situ trauma simulation trainings over a period of 13 months. The data consist of vignettes developed and written from field notes. The analysis was informed by the cultural-historical activity theory.

Leadership in a trauma team during an in situ simulation training emerges from a complex system of agencies taking place simultaneously. Contextual elements contributed to the goal. Clarity of roles and task division, strong execution of leadership at critical points, active communication and maintenance of disciplined communication helped to overcome difficulties. The team developed coordination of the process in conjunction with the care.

The study considers trauma leadership to be a practical phenomenon emerging from the trauma team’s sociomaterial context. The results can be used to develop non-technical skills training within the field of simulation-based medical training.

Emergency services are critical for high‐quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (US) acute care hospital staff's ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers.

Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5,000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities.

US acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, US emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staff's ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state‐of‐the‐art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement.

This research uses the AHA annual surveys, which represent self‐reported data by individual hospital staff. However, the AHA expends significant resources to validate reported information and the annual survey data are widely used for hospital research.

The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure.

This article has important information on US emergency service availability in the hospital industry.

Whilst chemsex is a relatively new phenomenon, trauma is not. Freud borrowed the word from physical medicine, where it was used to describe tissue damage, and applied it, for the first time, as a metaphor to a psychological process by which the protective functioning of the mind can too be pierced and wounded by events. The chemsex environment hosts a myriad of potentially traumatising scenarios and experiences, though perhaps disguised as exhilaration or excitement. The paper aims to discuss these issues.

The paper is a practitioner’s experience.

These experiences piled on top of childhood experiences of being “less than” for being gay, can be responsible for widespread undiagnosed post-traumatic stress disorder (PTSD) among those who engage in chemsex. This paper explores this possibility and offers solutions.

Compounded trauma and PTSD symptoms amongst MSM who engage in chemsex has to date, not been researched.

An emerging evidence base, and increased awareness of the effects of trauma on the body, advocates a sensory-based approach to treatment with posttraumatic stress and complex trauma survivors. This paper aims to identify, analyse and summarise the empirical evidence for the sensory-based interventions, which occupational therapists are using in the treatment of adult and adolescent trauma survivors.

An integrative review of the literature was undertaken. Both empirical and conceptual papers were included. An inductive approach and constant comparative method were used to understand and synthesise the research.

The literature search yielded 18 papers describing the types of sensory-based interventions used, sensory processing (SP) patterns and the context and evidence for sensory-based occupational therapy practice with trauma survivors. Nine of the studies were empirical and nine were conceptual and review papers. Themes identified included: atypical SP patterns; type of sensory-based intervention used with trauma survivors; and transdisciplinary treatment programmes can reduce the symptoms of trauma.

Sensory-based interventions with adult and adolescent trauma survivors are emerging as promising areas of practice and research in the literature. Although empirical data is limited, the sensory needs of the body in processing trauma experiences is becoming more recognised and are supported by the atypical SP patterns identified in survivors. A sensory-based, transdisciplinary approach to treatment has the potential to be effective in treating the trauma survivor.

With a skill base in sensory integration and occupational analysis, occupational therapists have much to offer the field of trauma studies. This review begins to address the gap in the literature, recommending more rigorous controlled outcome research with larger sample sizes, person-centred studies focussing on the trauma survivor’s perspective and continuing professional development and mentorship for occupational therapists working with this population.

The paper analyses four different perspectives on well‐being: the medical viewpoint and the hegemony of trauma, the cultural approach and the balance of social, spiritual and natural realms, the psycho‐social position and the scrutiny of the social environment, and multi‐levelled ecological models that integrate multiple layers. The paper advocates a shift away from analyses of localities/phases/contexts and well‐being towards those of processes, predicated on the separation of physical dis(re)‐locations from psychological dis(em)‐placements. When examining processes and negotiations with life events, of which displacement is one, well‐being is understood as a process of being ‘of’ rather than being ‘in’.