title: Implementation of a trauma system in Norway: a national survey.
abstract: BACKGROUND
  Trauma systems have improved outcomes for injured patients, but might be challenging to implement. We assessed the implementation of a trauma system in Norway after recommendations for a national trauma system were published in 2007, with a focus on elements in acute care hospitals.
  
  
  METHODS
  All hospitals in Norway, except for the four regional trauma centres, admitting injured patients at the time of the study were included in a telephone survey. The questionnaire was administered during May 2013 by the regional trauma coordinators who interviewed the local trauma coordinator and/or the local doctor responsible for trauma care in all the acute care hospitals. The main categories were availability of the trauma team and team training, written procedures, preparedness and training of personnel. The compliance to a set of 17 predefined trauma system criteria was evaluated at each institution.
  
  
  RESULTS
  Of the 35 acute care hospitals in Norway admitting trauma patients at the time of the survey, all were included. The median number of fulfilled criteria was 14. Major deficiencies were found in fulfilling competence criteria, maintaining a local trauma registry, and trauma audits. The number of fulfilled criteria correlated strongly with the size of the hospital and the frequency of trauma team activation.
  
  
  CONCLUSIONS
  Shortcomings in requirements for lower-level trauma care hospitals correlate to hospital size and frequency with which the trauma team is activated. In order to fulfill the minimum requirements, smaller hospitals should receive more attention.
authors.affiliation: Department of Gastrointestinal Surgery, University Hospital North Norway, Tromsø, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Dehli
authors.forename: T
authors.initials: T
authors.lastname: Gaarder
authors.forename: B J
authors.initials: BJ
authors.lastname: Christensen
authors.forename: O P
authors.initials: OP
authors.lastname: Vinjevoll
authors.forename: T
authors.initials: T
authors.lastname: Wisborg
mesh_terms: D006801:Humans; D009664:Norway; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014193:Trauma Centers / Q000706:statistics & numerical data*