Access to specialist care: Optimizing the geographic configuration of trauma systems.
BACKGROUND
The optimal geographic configuration of health care systems is key to maximizing accessibility while promoting the efficient use of resources. This article reports the use of a novel approach to inform the optimal configuration of a national trauma system.


METHODS
This is a prospective cohort study of all trauma patients, 15 years and older, attended to by the Scottish Ambulance Service, between July 1, 2013, and June 30, 2014. Patients underwent notional triage to one of three levels of care (major trauma center [MTC], trauma unit, or local emergency hospital). We used geographic information systems software to calculate access times, by road and air, from all incident locations to all candidate hospitals. We then modeled the performance of all mathematically possible network configurations and used multiobjective optimization to determine geospatially optimized configurations.


RESULTS
A total of 80,391 casualties were included. A network with only high- or moderate-volume MTCs (admitting at least 650 or 400 severely injured patients per year, respectively) would be optimally configured with a single MTC. A network accepting lower-volume MTCs (at least 240 severely injured patients per year) would be optimally configured with two MTCs. Both configurations would necessitate an increase in the number of helicopter retrievals.


CONCLUSIONS
This study has shown that a novel combination of notional triage, network analysis, and mathematical optimization can be used to inform the planning of a national clinical network. Scotland's trauma system could be optimized with one or two MTCs.


METHODS
Care management study, level IV.
From the Departments of Surgery (J.O.J., J.D.H.) and Intensive Care Medicine (J.O.J.), Aberdeen Royal Infirmary and Health Services Research Unit (J.O.J., M.K.C.), University of Aberdeen, Aberdeen; Academic Unit of Surgery (J.J.M.), Glasgow Royal Infirmary; and Scottish Ambulance Service (R.L.). Glasgow; Department of Computing (H.W.), University of Surrey, Guildford; and School of Computer Science (S.H.), University of Birmingham, Birmingham, United Kingdom.
Jan O
JO
Jansen
Jonathan J
JJ
Morrison
Handing
H
Wang
Shan
S
He
Robin
R
Lawrenson
James D
JD
Hutchison
Marion K
MK
Campbell
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000458:organization & administration; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012606:Scotland; D013038:Specialization / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000458:organization & administration*; D014218:Triage / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*