Audit of time to emergency trauma laparotomy

Background: An analysis of the process of care may improve quality of care within a trauma system. Early operative control of haemorrhage is vital and any delay before surgery may adversely affect outcome. Methods: Times from activation of the aeromedical team to arrival in the em ergency department and the operating room for patients with liver or spleen injury were analysed to identify factors that delayed laparotomy. These re sults were compared with those of a national database. Results: The median time from emergency call to operation was 127 min (140 min for blunt and 86 min for penetrating injuries). Time from arrival in th e emergency department to the operating room was 54 min (56 min for blunt a nd 37 min for penetrating injuries). An audit filter, set at the upper quar tile of the emergency call to operating room time, selected 21 patients who se records were examined; five correctable delays were identified. Compared with the national trauma database, these patients had longer on-scene time s, but significantly shorter times to operation from the emergency call (12 7 versus 161 min) and arrival at the emergency department (54 versus 115 mi n), although the patients were more severely injured (median Injury Severit y Score 34 versus 24). Conclusion: The time to emergency trauma laparotomy may be used effectively as an audit of process for the clinical governance of a trauma system.