IMPACT OF A STATEWIDE TRAUMA SYSTEM ON RURAL EMERGENCY DEPARTMENT PATIENT ASSESSMENT DOCUMENTATION

Objective: To determine the association of rural ED patient assessment documentation with state trauma system implementation, hospital traum a categorization level (i.e., Level-3 vs Level-4), injury diagnosis, a nd patient demographics.Methods: A pre- vs post-system implementation (historical control) analysis of trauma documentation was performed us ing a sample of rural ED trauma patients from 4 Level-3 and 5 Level-4 trauma hospitals, The medical records of patients with specific index diagnoses in 4 anatomic regions (head, chest, liver/spleen, and femur/ open-tibia) were reviewed for 3-year periods before statewide trauma s ystem implementation and after hospital categorization. Vital sign, % inspired O-2, and O-2 saturation determinations were identified relati ve to the first and the last vital signs documented on the ED record. If not documented in the medical chart within 5 minutes of the first o r last ED vital sign assessment, these measurements were considered mi ssing. Separately, neurologic documentation (initial and final) also w as sought for patients meeting criteria for an index head injury. Resu lts: Of 1,057 patients entered into the database, 532 were evaluated d uring the pre-system period and 525 were evaluated during the post-sys tem period. Overall, 47% had a head injury, 34% had a chest injury, 23 % had a femur/open-tibia injury, and 12% had a spleen/liver injury. Th ere were 142 (13%) patients with an injury in >1 index area. Except fo r initial systolic blood pressure, documentation of all other initial and final patient vital signs increased significantly (p < 0.05). Docu mentation of the Glasgow Coma Scale score (initial and final; p = 0.00 01) and a final pupil examination on head-injured patients (p = 0.025) also increased. The effects of hospital level, injury diagnosis, and patient demographics on documentation rate were minimal, Conclusion: T he study found overall improved ED documentation of trauma patient sta tus in association with implementation of a statewide trauma system. T his improvement in documentation suggests an enhanced process of care with trauma system participation.