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.
ABSTRACT
The most common site for hospital sentinel events due to care delays, secondary to waiting and/or inefficient processes, occurs in the emergency department (ED). Decreasing patient length of stay in an ED is a key initiative for many hospitals in order to maximize both quality and efficiency. The purpose of this practice improvement project was to (1) standardize front-end processes across a 6-hospital health system, (2) move non-sorting-related clinical questions out of triage, and (3) improve door-to-triage and door-to-provider times. The project occurred within a 6-hospital East Coast health system. This was a continuous quality improvement initiative utilizing the Donabedian theoretical model, plus the DMAIC method, for process improvement. A system-wide performance work team was formed including ED leaders and staff; site-specific implementation teams were also formed. Rapid triage implementation was effective in producing statistically significant improvement in door-to-triage, door-to-provider, and ED length of stay for discharged patients at 3 of the 6 sites. Further performance improvement projects in this area are needed to better understand the generalizability of this process in other EDs. Furthermore, from a leadership perspective, additional investigation is needed into the cost savings as well as shared labor opportunities that may exist when policies and processes are standardized across a system's service line.
