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Impact on process of trauma care delivery 1 year after the introduction of a trauma program in a provincial trauma center.

BACKGROUND
Trauma care delivery in Canada, even in major trauma centers, usually devolves to the most involved service. For patients with multisystem injuries, this is not always optimal and aspects of care outside the domain of the primary service are apt to be overlooked. Trauma care is necessarily multidisciplinary, and to be optimal, appropriate integration of the care process and prioritization are required. The purpose of this study was to examine the impact on care in a busy provincial trauma center, after the introduction of a trauma program with a clinical trauma service, revised trauma protocols, and a dedicated trauma unit.


METHODS
Data were collected prospectively before and during the introduction of the program. Aspects of care studied included trauma patient volume, compliance with trauma team activation and trauma consultation protocols, delays to the operating room for hypotension or open fractures, delays in disposition to the unit, average length of stay, and mortality based on Trauma and Injury Severity Score analysis. Data are presented summarized by quarter, one before and four after the introduction of the program. Variance tracking was introduced before the last quarter. Differences between preprogram and postprogram performance were assessed by using analysis of variance (asterisks indicates p < 0.05 compared with preprogram performance).


RESULTS
Trauma unit average length of stay decreased from 10.15 days initially to 9.66 and 9.14* days at 6 and 12 months, reducing costs. Improved survival was demonstrated by Trauma and Injury Severity Score methodology with z score achieving significance compared with Major Trauma Outcome Study outcomes after program implementation.


CONCLUSION
Trauma care improvement can be achieved by a multidisciplinary team focusing on the process of care, developing a dedicated trauma service to manage the more seriously injured patients, collecting them onto a single unit, and initiating program management.