PATIENT SAFETY

Patient Safety

Patient Safety

Abstract

Background

Regionalized trauma systems have been shown to improve the outcome of seriously injured patients. However, it is not clear which components of these systems have the most impact on patient outcomes. The study evaluates the association between implementation of a single, dedicated trauma admitting service at an urban trauma centre and subsequent patient outcomes.

Methods

This was a retrospective review of prospectively collected trauma registry data at the St George Public Hospital, a level I urban trauma centre in Sydney, Australia. Two concurrent 18-month periods, before and after implementation of a full-time trauma service, were compared for differences in patient mortality, complication rates, and ED, ICU and hospital lengths of stay.(Cornwell,2003)

Results

There were 962 patients admitted to the hospital in the 18 months immediately preceding the implementation of the trauma service (the PRE group) and 990 patients in the subsequent 18 months (the POST group). There were no significant differences between groups with respect to patient demographics or mechanism of injury, although a higher proportion of patients in the POST group had injury severity scores (ISS) above 15 (30.6% versus 24.8%, p = 0.02). There was an 8% reduction in death rate among the most severely injured patients (ISS > 15), in the POST group as compared to the PRE group (12.2% and 20.2% respectively, p = 0.007).

Conclusions

The implementation of a full-time trauma service in this hospital was associated with a reduction in death rate among the most severely injured patients, and a decrease in LOS in patients with an ISS < 15.

Introduction

In 2002 the State of New South Wales Department of Health appropriated funds to all regional Sydney trauma centers for the purpose of augmenting trauma care. Consequently, the decision was made by the St George Hospital administration and the Department of Surgery to use these funds to recruit and retain a full-time Trauma Medical Director, who would be charged with developing a dedicated trauma service. On 1 November 2003, the new Trauma Director assumed leadership of a newly created trauma service which admitted and managed all seriously injured patients in the hospital. This led to several changes in the hospital's approach to care of the injured, the most salient of which are enumerated below. (Cornwell,2003)

Appointment of a full-time Trauma Medical Director (TMD).

Appointment of two full-time trauma service surgical and medical trainees. Senior-level surgical registrars and junior-level non-surgical interns were assigned to 3-month rotations on the trauma service. These trainees, under the direct supervision of the TMD, were responsible for attending all emergency department (ED) trauma activations and participating in the primary and secondary survey of newly arrived patients, expediting further diagnostic procedures outside the ED, coordinating care between relevant subspecialties, and assisting with the day-to-day management of the patients on the wards.

Admission of all trauma patients to a single inpatient trauma service. After 1 November 2003, injured patients were admitted directly to the trauma service (under the care of the TMD) during regular hours (07:30-17:00 h) and on those nights on which the TMD was on call (mean of ...