Gh. Tinkoff et al., IMPACT OF A 2-TIERED TRAUMA RESPONSE IN THE EMERGENCY DEPARTMENT - PROMOTING EFFICIENT RESOURCE UTILIZATION, The journal of trauma, injury, infection, and critical care, 41(4), 1996, pp. 735-740
Objective: The purpose of this prospective study was to assess the imp
act of a two-tiered trauma response protocol on the expediency of iden
tification, evaluation, and treatment of trauma patients in the Emerge
ncy Department. Materials and Methods: At a Level I Trauma Center serv
ing a suburban/urban population of approximately one million people, E
mergency Department length of stay was tabulated for all consecutive T
rauma Service admissions 6 months before and 6 months after implementa
tion of a two-tiered trauma response protocol, This protocol, which us
es specific triage criteria, consisted of the standard Surgery-supervi
sed trauma code response and an additional Emergency Medicine-supervis
ed trauma alert response. Results: Trauma Service admissions numbered
532 in the pre-protocol period and 512 in the period after implementat
ion of the protocol, In the first period, the Emergency Department len
gth of stay was 289 minutes; in the second period, it was 241 minutes,
Of the 512 patients in the post-protocol period, 183 were triaged to
the new trauma alert group, reducing the number of Trauma Service cons
ultations and decreasing Emergency Department length of stay by 139 mi
nutes, The two levels of trauma response allowed accurate identificati
on of the most seriously injured patients and improved the ability to
predict those patients who would require direct disposition to the ope
rating room or intensive rare unit. Conclusions: Implementation of a t
wo-tiered trauma response significantly decreased Emergency Department
length of stay, allowed Emergency Medicine physicians to more rapidly
identify, evaluate, and treat trauma patients requiring hospitalizati
on, improved identification of patients requiring operating room or in
tensive care unit resources, and was time efficient and resource effic
ient.