AbstractObjectives & Background
Appropriate activation of multi-disciplinary trauma teams improves outcome for severely injured patients, but can disrupt normal service in the rest of the hospital. Derriford Hospital uses a two-tiered trauma team activation system. The emergency department (ED) trauma team is activated in response to a significant traumatic mechanism; the hospital trauma team is activated when this mechanism co-exists with physiological abnormality or specific anatomical injury. The aim of this study was to compare characteristics, process measures and outcomes between patients treated by ED or hospital trauma teams to evaluate the approach in a UK setting and to estimate any cost savings involved. Figure 1 outlines the composition and activation criteria of the teams.Methods
A retrospective database review was performed, using the TARN database and the local source trauma database. All patients who activated a trauma team between 1 Apr 12 to 30 Sep 12 were included. Patients were categorised according to the type of trauma team activated to receive them. Data included time to primary survey X-rays, time to CT, time to intubation, numbers discharged from ED, ICU admission, injury severity score (ISS), and mortality. Cost savings associated with activating an ED rather than hospital response were extrapolated from previously described methodology.Results
During the study period 456 patients activated a trauma team, 358 ED and 98 hospital (see Figure 2). Patients seen by the ED team were significantly less likely to have severe injury or require hospital admission, intubation, emergency operation or blood transfusion. Differences in time taken to key investigations were statistically but not clinically significant. The cost saving of avoiding hospital team activation for those patients not requiring specialist care was estimated at £180,663 per annum.Conclusion
A two-tiered trauma team activation system is an efficient, safe and cost-effective way of dealing with trauma patients presenting to a Major Trauma Centre in the UK.