Abstract
BackgroundTiered trauma team response may contribute to efficient in-hospital trauma triage by reducing the amount of resources required and by improving health outcomes. This study evaluates current practice of trauma team activation (TTA) in Dutch emergency departments (EDs).MethodsA survey was conducted among managers of all 102 EDs in the Netherlands, using a semi-structured online questionnaire.ResultsSeventy-two questionnaires were analysed. Most EDs use a one-team system (68 %). EDs with a tiered-response receive more multi trauma patients (p < 0.01) and have more trauma team alerts per year (p < 0.05) than one-team EDs. The number of trauma team members varies from three to 16 professionals. The ED nurse usually receives the pre-notification (97 %), whereas the decision to activate a team is made by an ED nurse (46 %), ED physician (30 %), by multiple professionals (20 %) or other (4 %). Information in the pre-notification mostly used for trauma team activation are Airway-Breathing-Circulation (87 %), Glasgow Coma Score (90 %), and Revised Trauma Score (85 %) or Paediatric Trauma Score (86 %). However, this information is only available for 75 % of the patients or less. Only 56 % of the respondents were satisfied with their current in-hospital trauma triage system.ConclusionsTrauma team activation varies across Dutch EDs and there is room for improvement in the trauma triage system used, size of the teams and the professionals involved. More direct communication and more uniform criteria could be used to efficiently and safely activate a specific trauma team. Therefore, the implementation of a revised national consensus guideline is recommended.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0185-0) contains supplementary material, which is available to authorized users.
Highlights
Tiered trauma team response may contribute to efficient in-hospital trauma triage by reducing the amount of resources required and by improving health outcomes
The emergency departments (EDs) with a tiered-response receive more multi trauma patients annually (p < 0.01), have more trauma team alerts per year (p < 0.05) and are larger than the one-team EDs, according to the total number of ED patients per year and number of full-time equivalent (FTE) emergency nurses (Table 1)
This study found that most Dutch EDs use a one-team trauma triage system, a large variation was found in size and composition of trauma teams and the team activation (TTA) process
Summary
Tiered trauma team response may contribute to efficient in-hospital trauma triage by reducing the amount of resources required and by improving health outcomes. Since the introduction of trauma teams, most emergency departments (EDs) worldwide use a one-team trauma response: one type of trauma team is activated for every incoming trauma patient. A system with a tiered-response has been shown to contribute to a safe and efficient TTA by reducing the amount of resources required and by improving patient outcomes, but may be inappropriate in EDs with a low number of trauma patients or with less experience in trauma care [4, 6,7,8, 10,11,12,13,14, 16]
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