Delivery of Appropriate Care to Trauma Patients by Secondary Trauma Diversion

Abstract Description

Proposed Topic (Most preferred): :

Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)

Authors (including presenting author) :

Yeung JHH(1), Hui TL(1), Chiu KY(2), Lin WH(3)

Affiliation :

1. Accident of Emergency Department, Princess of Margaret Hospital (PMH), 2. Accident of Emergency Department, Caritas Medical Centre (CMC) 3. Accident of Emergency Department, Yan Chai Hospital (YCH)

Introduction :

Trauma is a leading cause of death and loss of workdays in Hong Kong. Researches have suggested that timely provision of care in dedicated trauma centers can improve outcomes. PMH is one of the trauma centers (TC) in Hong Kong and provides professional care to major trauma patients in Kowloon West Cluster (KWC). Ambulances directly send the major trauma patients to PMH by Primary Trauma Diversion. However, there are some major trauma patients are sent to closest non-trauma center hospitals and they required secondary trauma diversion (STD) to the TC timely. To ensure the major trauma patients are sent to TC from local hospitals correctly and effectively, STD is one of the key elements on trauma system and therefore the guideline and criteria are established to guide practice.

Objectives :

To evaluate the appropriateness of rapid transfer of trauma patients who meet the set criteria in the emergency departments (EDs) of CMC, YCH and NLTH to PMH by STD.

Methodology :

All the STD patients who admitted to CMC, YCH and NLTH and STD to PMH form 1/1/2021 -31/12/2022 were reviewed by the working group which consisted of Associate Consultants from each KWC EDs and a Nurse Consultant (Trauma). They reviewed each case and provided comments on the appropriateness independently and classify them as “correct” or over diverted.

Result & Outcome :

In these two years, there were total 120 trauma patients (CMC 44, YCH 42 and NLTH 34) were STD to PMH. Patient age ranged 3 years to 86 years and the mean SD was 43.220.7 years. There were 93 male and 27 female patients.30 (25%) were major trauma (ISS >15) patients, 54 (45%) moderate trauma (ISS 5-15) patients, and 36 (30%) were minor trauma (ISS 1-4) patients. During inter-hospital transport, 52 (43%) patients were escorted by both doctors and nurses and 67 (55%) patients were escorted by nurses only. 59 (49.2%) patients were admitted to ICU and the Intensive Care Unit length of stay (LOS)mean SD was 3.3 4.7 days. The hospital LOS ranged from 1-142 days and the meanSD was 12.924.9 days, Glasgow Outcome Scale of patients, 82 (68%) had good recovery, 25 (21%) moderate disability, 2 (1.7%) severe disability, 2 (1.7%) vegetative state and 9 (7.5%) deaths. The appropriateness was reviewed the working group and the results demonstrated that 113 (94%) were diverted correctly and only 7(6%) were over diverted. The guideline compliance rate was high which indicated the local hospitals could STD trauma patients to the TC appropriately and effectively.