title: The Effect of Availability of Manpower on Trauma Resuscitation Times in a Tertiary Academic Hospital.
abstract: For trauma patients, delays to assessment, resuscitation, and definitive care affect outcomes. We studied the effects of resuscitation area occupancy and trauma team size on trauma team resuscitation speed in an observational study at a tertiary academic institution in Singapore.
  
  
  
  From January 2014 to January 2015, resuscitation videos of trauma team activated patients with an Injury Severity Score of 9 or more were extracted for review within 14 days by independent reviewers. Exclusion criteria were patients dead on arrival, inter-hospital transfers, and up-triaged patients. Data captured included manpower availability (trauma team size and resuscitation area occupancy), assessment (airway, breathing, circulation, logroll), interventions (vascular access, imaging), and process-of-care time intervals (time to assessment/intervention/adjuncts, time to imaging, and total time in the emergency department). Clinical data were obtained by chart review and from the trauma registry.
  
  
  
  Videos of 70 patients were reviewed over a 13-month period. The median time spent in the emergency department was 154.9 minutes (IQR 130.7-207.5) and the median resuscitation team size was 7, with larger team sizes correlating with faster process-of-care time intervals: time to airway assessment (p = 0.08) and time to disposition (p = 0.04). The mean resuscitation area occupancy rate (RAOR) was 1.89±2.49, and the RAOR was positively correlated with time spent in the emergency department (p = 0.009).
  
  
  
  Our results suggest that adequate staffing for trauma teams and resuscitation room occupancy are correlated with faster trauma resuscitation and reduced time spent in the emergency department.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Timothy Xin Zhong
authors.identifier: 0000-0001-5938-2304
authors.initials: TX
authors.lastname: Tan
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Nathaniel Xin Ern
authors.initials: NX
authors.lastname: Quek
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
authors.forename: Zhi Xiong
authors.initials: ZX
authors.lastname: Koh
authors.affiliation: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore.
authors.forename: Nivedita
authors.initials: N
authors.lastname: Nadkarni
authors.affiliation: Trauma Service, Department of General Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: Kanageswari
authors.initials: K
authors.lastname: Singaram
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
authors.forename: Andrew Fu Wah
authors.initials: AF
authors.lastname: Ho
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.|Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
authors.affiliation: Trauma Service, Department of General Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: Ting Hway
authors.identifier: 0000-0001-9234-4529
authors.initials: TH
authors.lastname: Wong
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000706:statistics & numerical data; D012151:Resuscitation / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D000078329:Workforce; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult