title: Improving overtriage of aeromedical transport in trauma: a regional process improvement initiative.
abstract: BACKGROUND
  Aeromedical transport (AMT) is an effective but costly means of rescuing critically injured patients. Although studies have shown that it improves survival to hospital discharge compared with ground transportation, an efficient threshold or universal criteria for this mode of transport remains to be established. Herein, we examined the effect of implementing a Trauma Advisory Committee (TAC) initiative focused on reducing AMT overtriage (OT) rates.
  
  
  METHODS
  TAC outreach coordinators implemented a process improvement (PI) initiative and collected data prospectively from January 2007 to December 2011. OT was defined as patients who were airlifted from scene and later discharged from the emergency department. Serving as liaisons to surrounding counties, TAC outreach coordinators conducted quarterly PI meetings with local emergency medical service agencies. Patients were grouped into those who were airlifted from TAC counties versus counties outside TAC's jurisdiction (non-TAC). Standard statistical methods were used.
  
  
  RESULTS
  From 2007 to 2011, 3,349 patients were airlifted from 30 counties, 1,427 (43%) from TAC counties and 1,922 (57%) from non-TAC counties. The OT rates from TAC counties declined compared with non-TAC counties each year and reached statistical significance in 2008 (17% vs. 23%, p < 0.05), 2009 (11% vs. 17%m p < 0.05), and 2011 (6% vs. 12%, p < 0.05). The reduction in OT continued over the study duration, with improvement in TAC counties compared with previous years.
  
  
  CONCLUSIONS
  Implementation of a regional TAC PI initiative focused on OT issues led to a more efficient use of AMT.
  
  
  METHODS
  Prognostic study, level III; therapeutic study, level IV.
authors.affiliation: F.H. Sammy Ross Jr. Trauma Center, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA.
authors.forename: Blair A
authors.initials: BA
authors.lastname: Wormer
authors.forename: Greg P
authors.initials: GP
authors.lastname: Fleming
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Christmas
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
authors.forename: Michael H
authors.initials: MH
authors.lastname: Thomason
authors.forename: Toan
authors.initials: T
authors.lastname: Huynh
mesh_terms: D000328:Adult; D026683:Advisory Committees / Q000458:organization & administration*; D000367:Age Factors; D017732:Air Ambulances / Q000191:economics / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000458:organization & administration; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014187:Transportation of Patients / Q000458:organization & administration; D014193:Trauma Centers; D016896:Treatment Outcome; D014218:Triage / Q000458:organization & administration*; D014481:United States; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D055815:Young Adult