Trauma performance improvement (PI) is part art and part science. I tend to segregate the process into 3 segments: inputs, processing, and outputs. There are lots of possible inputs, including violation of specific audit filters (too long to OR, open fracture delay, etc.),  referrals from M&M discussions, incident reports, and video reviews of trauma resuscitations, to name a few.

There is one PI input that has the potential to be a problem, though: word of mouth. You know, someone tells the trauma program manager that things just didn’t go well during that last trauma resuscitation. This is a perfectly legitimate way to identify PI issues. However, “word of mouth” can be categorized by source into “identified” and “anonymous.” 

Word of mouth sources that are identified are not a problem. Anonymous ones are. All too often, these unsigned notes or suggestion box drops or anonymous phone messages are initiated by someone with an axe to grind. Most of the time, there is no basis for the incident that has been reported. Your PI program can spend lots of time and energy trying to track down these perceived “problems”, and nothing ever comes of it.

I have two other major problems with unsourced word of mouth “tips”:

• There is no way to get additional information about the event from the source
• It is not possible to thank the source for the information and let them know what was done to correct the issue

Bottom line: Performance improvement “tips” from anonymous sources are usually unfounded and a waste of time to investigate. Let it be known that your PI program is happy to receive written or verbal notices of potential problems that need to be pursued. However, every request must have a name and contact number and/or email included.

Your PI program should publicize that you will keep your all sources confidential. This is critically important because they might be disclosing sensitive information for which there might be personal repercussions. But at the same time, make sure that everyone knows that anonymous tips cannot be pursued and will be discarded.

If you do use a phone tip line, make it clear to callers that they must identify themselves so you can update them on the progress of your investigation. The same goes for dropoff suggestion boxes. Ensure an informative sign so that everyone knows the routine. This will ensure that you get real, actionable tips to pursue and you can give credit where credit is due once you’ve fixed the issue.