Treatment provider is most predictive of ED dismissal in minimally-injured trauma patients: a retrospective review

Journal of Trauma Management & Outcomes

Ruth Wetta¹  Elizabeth Ablah¹  Diana Lippoldt⁴  Francie H Ekengren⁴  Rosalee E Zackula¹  Gina M Berg³  Diane L S Hunt² 

[1] University of Kansas School of Medicine – Wichita, Preventive Medicine and Public Health, Wichita, Kansas;Kansas Surgical Consultants, Wichita, Kansas;Medical Staff Office, Wesley Medical Center, 550 N. Hillside, Wichita, KS 67214, Kansas;Wesley Medical Center Trauma Services, Wichita, Kansas

关键词: Triage;    Trauma centers;    Physicians;    Hospitalizations;    Emergency medicine;    Critical care;   

Others  :  800967
DOI  :  10.1186/1752-2897-7-5

 received in 2012-02-06, accepted in 2013-05-06,  发布年份 2013

【 摘 要 】

Background

Secondary triage protocols have been described in the literature as physiologic (first-tier) criteria and mechanism-related (second-tier) criteria to determine the level of trauma activation. There is debate as to the efficiency of triage decisions based on mechanism of injury which may result in overtriage and overuse of limited trauma resources. Our institution developed and implemented an advanced three-tier trauma alert system in which stable patients presenting with blunt traumatic mechanism of injury would be evaluated by the emergency department (ED) physician rather than the trauma surgeon. The American College of Surgeons Committee on Trauma (ACSCOT) requires that operational changes be monitored and evaluated for patient safety and performance. The primary aim of this study was to evaluate the process, as well as outcomes, of patient care pre and post implementation of the new triage protocol. The secondary aim was to determine predictor variables that were associated with ED dismissal.

Methods

A retrospective blinded pre/post process change implementation explicit chart review was conducted to compare process and outcomes of minimally injured trauma patients who were field triaged by mechanism of injury. Generalized linear modeling was performed to determine which predictor variables were associated with ED dismissal.

Results

There were no significant differences in minutes to physician evaluation, CT scan, OR/ICU disposition, readmission rates, safety or quality. Significant differences only occurred in time to chest x-ray, length of stay in ED, and ED dismissal rates. Trauma surgeon and ED physician patient groups did not differ on ISS, age, or sex. The only significant predictor for ED dismissal was treatment provider, with ED physicians 3.6 times more likely to dismiss the patient from the emergency department.

Conclusions

ED physicians provided compble care as measured by safety, timeliness, and quality in minimally-injured patients triaged to our trauma center based only on mechanism of injury. Moreover, ED physicians were more likely to dismiss patients from the ED. A three-tiered internal triaging protocol can redirect resource usage to reduce the burden on the trauma service. This may be increasingly beneficial in trauma models in which the trauma surgeons also serve as critical care intensivists.

【 授权许可】

   
2013 Hunt et al.; licensee BioMed Central Ltd.

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