title: Impact of the introduction of an integrated adult retrieval service on major trauma outcomes.
abstract: OBJECTIVE
  The primary aim of this study was to examine the impact of the introduction of an integrated adult critical care patient retrieval system in Victoria, Australia, on early clinical outcomes for major trauma patients who undergo interhospital transfer. The secondary aims were to examine the impact on quality and process measures for interhospital transfers in this population, and on longer-term patient-reported outcomes.
  
  
  METHODS
  This is a cohort study using data contained in the Victorian State Trauma Registry (VSTR) for major trauma patients >18 years of age between 2009 and 2013 who had undergone interhospital transfer. For eligible patients, data items were extracted from the VSTR for analysis: demographics, injury details, hospital details, transfer details, Adult Retrieval Victoria (ARV) coordination indicator and transfer indicator, key clinical observations and outcomes.
  
  
  RESULTS
  There were 3009 major trauma interhospital transfers in the state with a transfer time less than 24 h. ARV was contacted for 1174 (39.0%) transfers. ARV-coordinated metropolitan transfers demonstrated lower adjusted odds of inhospital mortality compared with metropolitan transfers occurring without ARV coordination (OR 0.39, 0.15 to 0.97). Adjusting for destination hospital type demonstrates that this impact was principally due to ARV facilitation of a Major Trauma Service as the destination for transferred patients (OR 0.41, 0.16 to 1.02). The median time spent at the referral hospital was lower for ARV-coordinated transfers (5.4 h (3.8 to 7.5) vs 6.1 (4.2 to 9.2), p<0.0001).
  
  
  CONCLUSIONS
  In a mature trauma system, an effective retrieval service can further reduce mortality and improve long-term outcomes.
authors.affiliation: Adult Retrieval Victoria, Ambulance Victoria, Essendon Fields, Victoria, Australia.
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Kennedy
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.affiliation: Adult Retrieval Victoria, Ambulance Victoria, Essendon Fields, Victoria, Australia.
authors.forename: Ben A
authors.initials: BA
authors.lastname: McKenzie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D000066891:Critical Care Outcomes; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000458:organization & administration* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: Trauma; Trauma, majot trauma management; critical care transport; helicopter retrieval; major trauma management