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. 2015 Nov;79(5):756-65.
doi: 10.1097/TA.0000000000000827.

Access to specialist care: Optimizing the geographic configuration of trauma systems

Jan O Jansen  1 , Jonathan J Morrison, Handing Wang, Shan He, Robin Lawrenson, James D Hutchison, Marion K Campbell
Affiliations

Access to specialist care: Optimizing the geographic configuration of trauma systems

Jan O Jansen et al. J Trauma Acute Care Surg. 2015 Nov.

Abstract

Background: The optimal geographic configuration of health care systems is key to maximizing accessibility while promoting the efficient use of resources. This article reports the use of a novel approach to inform the optimal configuration of a national trauma system.

Methods: This is a prospective cohort study of all trauma patients, 15 years and older, attended to by the Scottish Ambulance Service, between July 1, 2013, and June 30, 2014. Patients underwent notional triage to one of three levels of care (major trauma center [MTC], trauma unit, or local emergency hospital). We used geographic information systems software to calculate access times, by road and air, from all incident locations to all candidate hospitals. We then modeled the performance of all mathematically possible network configurations and used multiobjective optimization to determine geospatially optimized configurations.

Results: A total of 80,391 casualties were included. A network with only high- or moderate-volume MTCs (admitting at least 650 or 400 severely injured patients per year, respectively) would be optimally configured with a single MTC. A network accepting lower-volume MTCs (at least 240 severely injured patients per year) would be optimally configured with two MTCs. Both configurations would necessitate an increase in the number of helicopter retrievals.

Conclusion: This study has shown that a novel combination of notional triage, network analysis, and mathematical optimization can be used to inform the planning of a national clinical network. Scotland's trauma system could be optimized with one or two MTCs.

Level of evidence: Care management study, level IV.

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Figures

Figure 1
Figure 1
Study area and locations of candidate hospitals (excluding Shetland Isles). Locations in red indicate hospitals that could become MTCs, TUs, or LEHs. Locations in blue indicate hospitals that could become TUs or LEH. Hospitals in green could only become LEHs. The map also shows the locations of the three airfields with aeromedical retrieval assets. (Contains public sector information licensed under the Open Government Licence v3.0.).
Figure 2
Figure 2
Triage algorithm.
Figure 3
Figure 3
Tasking algorithm.
See this image and copyright information in PMC

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