Patient safety in differentiated (in-hospital) activation of the resuscitation room for severely injured patients

Abstract

Providing trauma services demands high personnel resources and structural costs. The goal of this study was to show if the assignment of trauma patients to adefined A or B resuscitation room treatment as amodified management concept is safe and feasible. Between May 2020 and January 2021, all resuscitation room trauma patients were included in this single center prospective observational study. All patients admitted to the resuscitation room underwent aclassification according to the German S3 guidelines grade of recommendation GoRA and GoRB in polytrauma and the status of the ABCDE sequence to an A and B resuscitation room. The classification was performed by the senior consultant on call via telephone after consultation and discussion of clinical findings. All 135 resuscitation room patients were included in the study of whom 42trauma patients were assigned to the A resuscitation room (A-SR) and 93were assigned to the B resuscitation room (B-SR). The comparison of the two groups showed that patients in the A‑SR group are more likely to be accompanied by aprehospital emergency physician (80.5%) than patients in the B‑SR group (55.5%). Patients in the B‑SR group showed asignificantly higher Glasgow coma scale (GCS). Using the eFAST emergency ultrasound protocol, 2.4% of the A‑SR and 4.3% of the B‑SR patients had trauma-associated pathologies, 26% of the A‑SR and only 3.2% of the B‑SR patients had to be admitted to the ICU, 21.4% of the A‑SR and 1% of the B‑SR patients died within 30days after trauma. The injury severity scores (ISS) of the A‑SR patients were significantly higher than in the B‑SR group (ISS 28.3vs. 6.8). The study confirmed that the assignment by the emergency department consultant according to the German S3guideline in combination with the ABCDE sequence into resuscitation room A or B treatment is feasible, does not compromise the quality of care and is efficient in the use of the personnel resources.