title: Can residents be effective trauma team leaders in a major trauma centre?
abstract: OBJECTIVE
  The overall objective of this study was to compare senior Emergency Department (ED) trainees (residents) with consultant trauma team leaders, assessing their influence on trauma team performance and patient outcomes. We aimed to identify the effect of seniority of leader on time-based performance measures and clinical outcomes.
  
  
  METHODS
  This retrospective study of prospectively collected data was conducted in an urban Major Trauma Centre which has a well-established trauma team. For the period covered by this study the trauma team was led by either an ED consultant or specialist registrar having completed a local trauma team leader development programme. Data from all adult trauma team activations for seriously injured trauma patients (ISS - Injury Severity Score >15) presenting between 1st January 2008 and 31st October 2009 were included. Performance measures included time to FAST, time to CT scan and time to haemorrhage control. Patient outcomes were mortality, critical care and hospital length of stay.
  
  
  RESULTS
  There were 579 patients seriously injured in the study period. Trainees led 126 (22%) of the trauma teams. Significant differences in times to diagnostics or haemorrhage control between trainees and consultants were only seen in patients presenting with shock. Compared with trainees, consultant team leaders were significantly more likely to achieve targets for diagnostic imaging (FAST <15 min: consultants 97% vs. 33% trainees, p<0.01; CT scan <60 min: 76% vs. 50%, p<0.01) and haemorrhage control (surgery or angiography <60 min: 82% vs. 54%, p<0.001). There was no significant difference in overall mortality between consultants and trainees (consultants 25% vs. trainees 27%, p 1.00). Critical care length of stay was also the same for both (consultants median 5 days vs. trainees median 5 days).
  
  
  CONCLUSIONS
  Consultant team leaders improve team performance, resulting in shorter times to diagnostic imaging, and faster transfer to haemorrhage control. The greatest benefit seems to be for bleeding patients. Clinical outcomes were similar for trainees and consultants in our major trauma centre.
authors: Trauma Outcomes Core, Centre for Neuroscience and Trauma Science, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom. elaine.cole@bartsandthelondon.nhs.uk
authors: E M
authors: EM
authors: Cole
authors: A
authors: A
authors: West
authors: R
authors: R
authors: Davenport
authors: S
authors: S
authors: Naganathar
authors: T
authors: T
authors: Kanzara
authors: M
authors: M
authors: Carey
authors: K
authors: K
authors: Brohi
mesh_terms: D000328:Adult; D000792:Angiography; D002983:Clinical Competence; D003422:Critical Care; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006470:Hemorrhage / Q000175:diagnosis / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007857:Leadership; D008131:London / Q000453:epidemiology; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012769:Shock / Q000175:diagnosis / Q000401:mortality; D013647:Task Performance and Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D000078329:Workforce; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000401:mortality