Initial management of trauma by a trauma team: effect on timeliness of care in a teaching hospital.
The objective of this study was to determine if timeliness of care would improve after implementation of the team approach in trauma management in a single teaching hospital. To make this determination, we used a before-and-after retrospective cohort series for a 550-bed teaching and tertiary referral hospital that was not a level 1 trauma center. We included all patients who presented to the Emergency Department and who were admitted to St. Paul's Hospital because of trauma during 2 baseline months (May and November 1987; n = 111) and 2 follow-up months (May and November 1990; n = 142). In 1988, a formal trauma team was developed to coordinate the care of trauma patients who were seen in the Emergency Department. Indications for calling the trauma team were based on the criteria of the American College of Surgeons for triage to a trauma center. We calculated elapsed time from assessment in the Emergency Department to arrival of the trauma surgeon, discharge from the Emergency Department, and arrival of the patient in the operating room (for urgent or emergent surgery). We also determined the Revised Trauma Score, the Injury Severity Score (1985 version), the crude mortality ratio, and the Z statistic (population outcome comparison). After implementation of the trauma team, median elapsed time from initial nursing assessment in the Emergency Department to arrival in the operating Room for blunt trauma patients decreased from 11.33 to 4.82 hours (P = .05), but there were no significant differences in any other measures of timeliness, crude mortality, or adjusted mortality. We conclude that implementation of a trauma team in a teaching hospital is associated with a minimal effect on timeliness of care for admitted trauma patients.
Dodek
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Department of Medicine, St Paul's Hospital, Vancouver, BC, Canada. pedodek@unixg.ubc.ca
Herrick
R
R
Phang
P T
PT
D000293:Adolescent; D000328:Adult; D000368:Aged; D001955:British Columbia; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006784:Hospitals, Teaching / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011247:Pregnancy; D012189:Retrospective Studies; D012621:Seasons; D013997:Time Factors; D014218:Triage; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000601:surgery / Q000628:therapy; D014950:Wounds, Penetrating / Q000601:surgery / Q000628:therapy