oa Service evaluation of the 2-tiered trauma call system in a London Trauma Unit

Background: Each hospital in the UK has a hospital trauma team which includes a multi-disciplinary team. However, the use of such team for minor trauma can lead to inappropriate use of healthcare resources. Thus, an “Emergency Department (ED) trauma team” including only ED staff was developed. The 2 teams together form the 2-tiered trauma system. Each team has its own activation criteria. Its effectiveness in the UK still requires further evaluations. Thus, an evaluation of its effectiveness is important. Only a few UK hospitals adopt this system. St Helier Hospital (SHH) is one of them.

Objectives: Our aim is to evaluate the effectiveness of new service which has been implemented in the Trauma Unit and its impact on the trauma care and service delivery.

Methods: Patients who activated the ED trauma system at SHH from 01/11/2014 to 30/04/2015 were included. This is a retrospective work, clinical notes were reviewed against two tiered trauma calls using SHH database.

Results: A total of 103 ED trauma calls were recorded. 65 cases (63.1%) should have been managed using the hospital team but were not. Overall, patient care was not adversely affected. In most cases, guidelines on “initial assessors”, “primary survey” and “fast scans” were followed. The survival rate was 100% with 55.3% home discharges. Injury mechanism was looked at to explain for the deviation. The “2 or more systems involved” sub-criterion was activated the most and could be argued to bring about most over-triage cases if trust trauma calls had been used.

Conclusions: The ED team at SHH have managed its patients safely and effectively despite a high guideline non-adherence rate. Improvements of the 2-tiered system effectiveness need an increase in the system awareness and a review of the system activation criteria.