Impact on process of trauma care delivery 1 year after the introduction ofa trauma program in a provincial trauma center

Background: Trauma care delivery in Canada, even in major trauma centers, u sually devolves to the most involved service. For patients with multisystem injuries, this is not always optimal and aspects of care outside the domai n of the primary service are apt to be overlooked, Trauma care is necessari ly multidisciplinary, and to be optimal, appropriate integration of the car e process and prioritization are required. The purpose of this study was to examine the impact on care in a busy provincial trauma center, after the i ntroduction of a trauma program with a clinical trauma service, revised tra uma protocols, and a dedicated trauma unit. Methods: Data were collected prospectively before and during the introducti on of the program. Aspects of care studied included trauma patient volume, compliance with trauma team activation and trauma consultation protocols, d elays to the operating room for hypotension or open fractures, delays in di sposition to the unit, average length of stay, and mortality based on Traum a and Injury Severity Score analysis. Data are presented summarized by quar ter, one before and four after the introduction of the program. Variance tr acking was introduced before the last quarter. Differences between preprogr am and postprogram performance were assessed by using analysis of variance (asterisks indicates p < 0.05 compared with preprogram performance), Results: Trauma unit average length of stay decreased from 10.15 days initi ally to 9.66 and 9.14* days at 6 and 12 months, reducing costs. Improved su rvival was demonstrated by Trauma and Injury Severity Score methodology wit h z store achieving significance compared with Major Trauma Outcome Study o utcomes after program implementation. Conclusion: Trauma care improvement can be achieved by a multidisciplinary team focusing on the process of care, developing a dedicated trauma service to manage the more seriously injured patients, collecting them onto a sing le unit, and initiating program management.