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. 2017 Sep 11;2(1):e000102.
doi: 10.1136/tsaco-2017-000102. eCollection 2017.

Trauma resource designation: an innovative approach to improving trauma system overtriage

Gail T Tominaga  1 , Imad S Dandan  1 , Kathryn B Schaffer  1 , Fady Nasrallah  1 , Melanie Gawlik R N  1 , Jess F Kraus  2
Affiliations

Trauma resource designation: an innovative approach to improving trauma system overtriage

Gail T Tominaga et al. Trauma Surg Acute Care Open. .

Abstract

Background: Effective triage of injured patients is often a balancing act for trauma systems. As healthcare reimbursements continue to decline,1 innovative programs to effectively use hospital resources are essential in maintaining a viable trauma system. The objective of this pilot intervention was to evaluate a new triage model using 'trauma resource' (TR) as a new category in our existing Tiered Trauma Team Activation (TA) approach with hopes of decreasing charges without adversely affecting patient outcome.

Methods: Patients at one Level II Trauma Center (TC) over seven months were studied. Patients not meeting American College of Surgeons criteria for TA were assigned as TR and transported to a designated TC for expedited emergency department (ED) evaluation. Such patients were immediately assessed by a trauma nurse, ED nurse, and board-certified ED physician. Diagnostic studies were ordered, and the trauma surgeon (TS) was consulted as needed. Demographics, injury mechanism, time to physician evaluation, time to CT scan, time to disposition, hospital length of stay (LOS), and in-hospital mortality were analyzed.

Results: Fifty-two of the 318 TR patients were admitted by the TS and were similar to TA patients (N=684) with regard to gender, mean Injury Severity Score, mean LOS and in-hospital mortality, but were older (60.4 vs 47.2 years, p<0.0001) and often involved in a fall injury (52% vs 35%, p=0.0170). TR patients had increased door to physician evaluation times (11.5 vs 0.4 minutes, p<0.0001) and increased door to CT times (76.2 vs 25.9 minutes, p<0.0001). Of the 313 TR patients, 52 incurred charges totaling US$253 708 compared with US$1 041 612 if patients had been classified as TA.

Conclusions: Designating patients as TR prehospital with expedited evaluation by an ED physician and early TS consultation resulted in reduced use of resources and lower hospital charges without increase in LOS, time to disposition or in-hospital mortality.

Level of evidence: Level II.

Keywords: ED management; cost-effective management; resource; triage.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Distribution of patients.
See this image and copyright information in PMC

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