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LaRosa SK, Stone XA, Fenninger AA, Harshaw NS, Hoffman KM, Moore KG, Perea LL. Effects of Time of Arrival on Trauma Patient Outcomes. Am Surg 2024; 90:2188-2193. [PMID: 38647268 DOI: 10.1177/00031348241248694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Arriving during "off hours" to the hospital can put patients at greater risk of complications or mortality given lesser staff. Our goal was to investigate this in trauma patients with an Injury Severity Score (ISS) of >15. We hypothesized that the patients admitted late at night and/or during the weekend, would have worse outcomes, delays to the operating room (OR), and longer lengths of stay (LOS) compared to those who arrive on a weekday during the day. METHODS We performed a retrospective study from 8/1/2019 to 8/1/2022 of all trauma patients with an ISS >15 at our Level 1 Trauma Center. Patients <18 years, dead on arrival, or transferred out were excluded. Univariate and multivariable analysis were performed comparing weekday vs weekend arrivals, day vs night shift arrivals, and with patients grouped as weekday day, weekday night, weekend day, and weekend night. The primary outcome was mortality. RESULTS 953 patients met inclusion criteria. The patients that arrived on the weekend and at night were significantly younger than their counterparts. A significantly greater percentage of Black patients arrived during night shift. Mortality, hospital LOS, and ICU LOS did not differ based on day or time of arrival. CONCLUSION Contrary to our hypothesis, our study did not find a significant difference in outcomes when evaluating based on a patient's time of arrival. This gives credence that our mature trauma center can provide the same level of care despite the time of a severely injured patient's time of arrival.
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Affiliation(s)
- Samantha K LaRosa
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Xander A Stone
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Ashley A Fenninger
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Nathaniel S Harshaw
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Kathryn M Hoffman
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Katherine G Moore
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Lindsey L Perea
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
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Bulte CSE, Mansvelder FJ, Loer SA, Bloemers FW, Den Hartog D, Van Lieshout EMM, Hoogerwerf N, van der Naalt J, Absalom AR, Peerdeman SM, Giannakopoulos GF, Schwarte LA, Schober P, Bossers SM. Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury. J Clin Med 2024; 13:2249. [PMID: 38673522 PMCID: PMC11051010 DOI: 10.3390/jcm13082249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: Severe traumatic brain injury (TBI) is a frequent cause of morbidity and mortality worldwide. In the Netherlands, suspected TBI is a criterion for the dispatch of the physician-staffed helicopter emergency medical services (HEMS) which are operational 24 h per day. It is unknown if patient outcome is influenced by the time of day during which the incident occurs. Therefore, we investigated the association between the time of day of the prehospital treatment of severe TBI and 30-day mortality. Methods: A retrospective analysis of prospectively collected data from the BRAIN-PROTECT study was performed. Patients with severe TBI treated by one of the four Dutch helicopter emergency medical services were included and followed up to one year. The association between prehospital treatment during day- versus nighttime, according to the universal daylight period, and 30-day mortality was analyzed with multivariable logistic regression. A planned subgroup analysis was performed in patients with TBI with or without any other injury. Results: A total of 1794 patients were included in the analysis, of which 1142 (63.7%) were categorized as daytime and 652 (36.3%) as nighttime. Univariable analysis showed a lower 30-day mortality in patients with severe TBI treated during nighttime (OR 0.74, 95% CI 0.60-0.91, p = 0.004); this association was no longer present in the multivariable model (OR 0.82, 95% CI 0.59-1.16, p = 0.262). In a subgroup analysis, no association was found between mortality rates and the time of prehospital treatment in patients with combined injuries (TBI and any other injury). Patients with isolated TBI had a lower mortality rate when treated during nighttime than when treated during daytime (OR 0.51, 95% CI 0.34-0.76, p = 0.001). Within the whole cohort, daytime versus nighttime treatments were not associated with differences in functional outcome defined by the Glasgow Outcome Scale. Conclusions: In the overall study population, no difference was found in 30-day mortality between patients with severe TBI treated during day or night in the multivariable model. Patients with isolated severe TBI had lower mortality rates at 30 days when treated at nighttime.
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Affiliation(s)
- Carolien S. E. Bulte
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
| | - Floor J. Mansvelder
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
| | - Stephan A. Loer
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
| | - Frank W. Bloemers
- Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Dennis Den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.D.H.); (E.M.M.V.L.)
| | - Esther M. M. Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.D.H.); (E.M.M.V.L.)
| | - Nico Hoogerwerf
- Department of Anesthesiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Helicopter Emergency Medical Service Lifeliner 3, 5408 SM Volkel, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Anthony R. Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Saskia M. Peerdeman
- Department of Neurosurgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Georgios F. Giannakopoulos
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
- Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Lothar A. Schwarte
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
| | - Patrick Schober
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
| | - Sebastiaan M. Bossers
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
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Vera-López JD, Heredia-Pi IB, Pérez-Núñez R, Hijar M. [Indicators to measure the performance of emergency trauma care]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:819-840. [PMID: 37995348 PMCID: PMC10721338 DOI: 10.5281/zenodo.10064412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/28/2023] [Indexed: 11/25/2023]
Abstract
The objective of this paper was to identify the main indicators used to measure the performance in emergency trauma care. A literature review was carried out in the electronic databases: PubMEd, LILACS and Epistemónikos, including publications between January 2011 and December 31, 2021, in Spanish, English and Portuguese. A total of 962 publications were identified. When reviewing the full text, 48 articles were included. The indicators were classified in the dimensions of process and results. 100 different indicators were identified to analyze the performance of emergency trauma care. 71% were process indicators, including service time and triage. In the results dimension 29 indicators were identified; mortality was the indicator most analyzed as well as length of stay. Six indicators on the disability of injured people and 14 indicators related to satisfaction were identified, the most frequent being complaints. Various indicators have been used to assess the performance of emergency trauma care. In the results dimension, the indicators related to satisfaction and disability after injuries have been little explored. Decision-makers and those responsible for emergency care must promote performance evaluation exercises to learn about their current situation using appropriate and sensitive indicators with the available data.
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Affiliation(s)
- Juan Daniel Vera-López
- Escuela de Salud Pública de México, Doctorado en Ciencias en Sistemas de Salud. Cuernavaca, Morelos, MéxicoEscuela de Salud Pública de MéxicoMéxico
| | - Ileana Beatriz Heredia-Pi
- Instituto Nacional de Salud Pública, Centro de Investigación en Sistemas de Salud. Cuernavaca, Morelos, MéxicoInstituto Nacional de Salud PúblicaMéxico
| | - Ricardo Pérez-Núñez
- Organización Panamericana de la Salud, Seguridad vial y prevención de lesiones no intencionales. Washington D.C., Estados UnidosOrganización Panamericana de la SaludEstados Unidos
| | - Martha Hijar
- Instituto Nacional de Salud Pública, Centro de Investigación en Sistemas de Salud. Cuernavaca, Morelos, MéxicoInstituto Nacional de Salud PúblicaMéxico
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Loi F, Lucchetta MR, Mameli C, Rosmarino R, Oppes G, Fuentes RJ, Avilez Gonzalez ID, Aviles Gonzalez CI. Study on the New Role of Civil and Military Air Rescue Nurses in the Italian Context. NURSING REPORTS 2023; 13:480-495. [PMID: 36976696 PMCID: PMC10053912 DOI: 10.3390/nursrep13010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/02/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
Context: An emergency medical nurse is a health professional who operates at a very high level in the field of emergencies. The nurses of the critical area departments of the Territorial Emergency Department currently operate in the Sardinian helicopter rescue service. The effectiveness of the treatment that these nurses administer can be attributed to the quality of the previous and recurrent training that this unit must undergo. Objective: This study's aim was to investigate the role of civil and military helicopter nurses in the context of Italian medical aid. Methods: A qualitative study, with a phenomenological approach, was conducted by interviewing 15 emergency medical nurses, using detailed recordings and transcripts. These findings were then compared to understand how nurses work outside their department of origin, how their training has influenced their ability to establish themselves outside it, and thus their ability to become part of a context considered to be of the highest level. Participants and research context: The personnel interviewed in this study were those who were working in the helibases of Cagliari, Olbia, and Alghero. The limitations of this study are linked to the impossibility of obtaining an internship at a company, because, at the time of the study, an agreement between the university and the Areus company was not active. Ethical considerations: Participation in this research was completely voluntary. In fact, the participants could cease participating at any time. Results: This study revealed issues related to training, preparation, motivation to carry out the role held, nursing autonomy, the willingness to collaborate between the various rescue organizations, the use of the helicopter rescue service, and possible improvements for this service. Conclusions: civil air rescue nurses can deepen their knowledge by examining the work of military air rescue nurses, because, although the operational contexts are different, some techniques used in a hostile environment are also applicable to civilian environments. By doing so, nurses could become independent team leaders for all intents and purposes, managing their own training, preparation, and technical skills.
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Affiliation(s)
- Francesca Loi
- Department of Medicine and Surgery, Nursing Faculty, University of Cagliari, 09124 Cagliari, Italy
| | - Maria Raffaela Lucchetta
- Department of Medicine and Surgery, Nursing Faculty, University of Cagliari, 09124 Cagliari, Italy
| | - Claudio Mameli
- Department of Medicine and Surgery, Nursing Faculty, University of Cagliari, 09124 Cagliari, Italy
| | - Roberta Rosmarino
- Department of Medicine and Surgery, Nursing Faculty, University of Cagliari, 09124 Cagliari, Italy
| | - Giulio Oppes
- Department of Medicine and Surgery, Nursing Faculty, University of Cagliari, 09124 Cagliari, Italy
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Riyapan S, Chantanakomes J, Somboonkul B, Shin SD, Chiang WC. Effect of Nighttime on Prehospital Care and Outcomes of Road Traffic Injuries in Asia: A Cross-Sectional Study of Data from the Pan-Asian Trauma Outcomes Study (PATOS). PREHOSP EMERG CARE 2021; 26:573-581. [PMID: 34464227 DOI: 10.1080/10903127.2021.1974990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Emergency response to a road traffic injury (RTI) plays a crucial role in patient survival, and the quality of the emergency response should be consistent regardless of the time of day. The aim of this study was to investigate prehospital care and survival outcomes compared between emergency response to RTI during the day and emergency response to RTI at night in Asia.Method: This cross-sectional study used data from the Pan-Asian Trauma Outcome Study (PATOS) that was conducted during 2015-2018. We included RTI patients who were transported to the emergency department (ED) by ground ambulance. That group was then categorized according to the time that the ambulance arrived on-scene. On-scene arrival during 8:00 am to 7:59 pm was defined as the daytime group, and arrival during 8:00 pm to 7:59 am was defined as the nighttime group. Multiple logistic regression was employed to identify factors associated with nighttime prehospital interventions and survival outcomes after adjustment for age, alcohol consumption, and injury severity score (ISS).Results: The final analysis included 20,105 RTI patients. Of those, 12,043 (60%) accidents occurred during the daytime, and 8,062 (40%) occurred at night. RTI patients at night were younger (mean age: 35.7 ± 17.3 vs. 39.5 ± 20.7; p < 0.001), had more alcohol consumption (15.0% vs. 4.2%; p < 0.001), and had more severe injuries (mean ISS: 6.5 ± 7.5 vs. 5.8 ± 7.0; p < 0.001) compared to the daytime group. The nighttime group had increased prehospital immobilization (adjusted odds ratio [aOR]: 1.22, 95% confidence interval [CI]: 1.14-1.31) and more prehospital intravenous (IV) access (aOR 1.36, 95%CI: 1.22-1.51). There was no significant difference in either basic or advanced airway management between the daytime and nighttime groups. The nighttime group had decreased survival in the ED (aOR: 0.80, 95%CI: 0.65-0.98); however, nighttime on-scene arrival did not impact survival to discharge (aOR: 1.10, 95%CI: 0.91-1.33).Conclusion: In the PATOS community, RTI patients that sustained their injuries at night received significantly more prehospital immobilization and IV access, and they had significantly decreased survival in the ED. The results of this study can be used to develop and enhance strategies to improve the care and outcomes of nighttime RTI in Asia.
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