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Matthews T, LaScala A, Tomkin T, Gaeta L, Fitzgerald K, Solomita M, Ragione B, Jahan TP, Pepic S, Apurillo L, Siegel V, Frederick A, Arrillaga A, Klein LR, Cuellar J, Raio C, Penta K, Rothburd L, Eckardt SA, Eckardt P. Resource Deployment in Response to Trauma Patients. Cureus 2023; 15:e49979. [PMID: 38058531 PMCID: PMC10697664 DOI: 10.7759/cureus.49979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 12/08/2023] Open
Abstract
Background Variance in the deployment of the trauma team to the emergency department (ED) can result in patient treatment delays and excess burden on ED personnel. Characteristics of trauma patients, including mechanism of injury, injury type, and age, have been associated with differences in trauma resource deployment. Therefore, this retrospective, single-site study aimed to examine the deployment patterns of trauma resources, the characteristics of the trauma patients associated with levels of trauma resource deployment, and the deployment impact on ED workforce utilization and non-trauma ED patients. Methodology This was an investigator-initiated, single-institution, retrospective cohort study of all patients designated as a trauma response and admitted to a community hospital's ED from July 01, 2019, through July 01, 2022. Results Resource deployment for trauma patients varied by mechanism of injury (p < 0.001), injury type (p < 0.001), and patient age groups (p < 0.001). Specifically, there was a lower average trauma activation for geriatric trauma patients with a fall as a mechanism of injury compared to all younger patient groups with any mechanism of injury (F(5) = 234.49, p < 0.001). In the subsample, there was an average of 3.35 ED registered nurses (RNs) allocated to each trauma patient. Additionally, the ED RNs were temporarily reallocated from an average of 4.09 non-trauma patients to respond to trauma patients, despite over a third of the trauma patients in the subsample being the trauma patients being discharged home from the ED. Conclusions Trauma activation responses need to be standardized with a specific plan for geriatric fall patients to ensure efficient use of trauma and ED personnel resources.
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Affiliation(s)
- Thomas Matthews
- Nursing, Good Samaritan University Hospital, West Islip, USA
| | - Alexa LaScala
- Nursing, Good Samaritan University Hospital, West Islip, USA
| | - Theresa Tomkin
- Nursing, Good Samaritan University Hospital, West Islip, USA
| | - Lisa Gaeta
- Nursing, Good Samaritan University Hospital, West Islip, USA
| | - Karen Fitzgerald
- Quality Improvement, Good Samaritan University Hospital, West Islip, USA
| | - Michele Solomita
- Nursing Administration, Good Samaritan University Hospital, West Islip, USA
| | - Barbara Ragione
- Quality Improvement, Good Samaritan University Hospital, West Islip, USA
| | | | - Saliha Pepic
- Research, City University of New York, New York, USA
| | | | | | - Amy Frederick
- Trauma, Good Samaritan University Hospital, West Islip, USA
| | - Abenamar Arrillaga
- Surgical Critical Care, Good Samaritan University Hospital, West Islip, USA
| | - Lauren R Klein
- Emergency Medicine, Good Samaritan University Hospital, West Islip, USA
| | - John Cuellar
- Orthopedic Surgery, Good Samaritan University Hospital, West Islip, USA
| | - Christopher Raio
- Emergency Medicine, Good Samaritan University Hospital, West Islip, USA
| | - Keri Penta
- Nursing/Performance Improvement, Good Samaritan University Hospital, West Islip, USA
| | | | - Sarah A Eckardt
- Data Scientist, Eckardt & Eckardt Consulting, LLC, St. James, USA
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ISS alone, is not sufficient to correctly assign patients post hoc to trauma team requirement. Eur J Trauma Emerg Surg 2020; 48:383-392. [PMID: 32556366 PMCID: PMC8825400 DOI: 10.1007/s00068-020-01410-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/28/2020] [Indexed: 01/10/2023]
Abstract
Purpose An injury severity score (ISS) ≥ 16 alone, is commonly used post hoc to define the correct activation of a trauma team. However, abnormal vital functions and the requirement of life-saving procedures may also have a role in defining trauma team requirement post hoc. The aim of this study was to describe their prevalence and mortality in severely injured patients and to estimate their potential additional value in the definition of trauma team requirement as compared to the definition based on ISS alone. Methods Retrospective analysis of a trauma registry including patients with trauma team activation from the years 2009 until 2015, who were 16 years of age or older and were brought to the trauma center directly from the scene. Patients were divided into a group with an ISS ≥ 16 vs. ISS < 16. For analysis a predefined list of abnormal vital functions and life-saving interventions was used. Results 58,723 patients were included in the study (N = 32,653 with ISS ≥ 16; N = 26,070 with ISS < 16). From the total number of patients that required life-saving procedures or presented with abnormal vital functions 29.1% were found in the ISS < 16 group. From the ISS < 16 group, 36.7% of patients required life-saving procedures or presented with abnormal vital signs. The mortality of those was 8.1%. Conclusions Defining the true requirement of trauma team activation post hoc by using ISS ≥ 16 alone does miss a considerable number of subjects who require life-saving interventions or present with abnormal vital functions. Therefore, life-saving interventions and abnormal vital functions should be included in the definitions for trauma team requirement. Further studies have to evaluate, which life-saving procedures and abnormal vital functions are most relevant.
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