Trauma triage -- Getting it right
Repository Posting Date2020-03-27T18:22:47Z
Author DetailsWendy Hyatt, BSN, RN, CEN; Stephen Clayton, RN, BSN, CEN; Kayla Hooper, RN; Elisha Nunley, BSN
Lead Author Sigma AffliationNon-member
Level of EvidenceN/A
Session H presented Tuesday, October 1, 2:30-3:30 pm
Purpose: The goal of Emergency Department (ED) trauma triage criteria is to ensure trauma patients receive the resources appropriate for their injuries. The American College of Surgeons (ACS) sets criteria for all trauma centers to evaluate under and over triage of trauma patients. Evidence-based revisions to trauma criteria are an imperative part of a trauma center’s performance improvement process. Annual evaluation of triage criteria, over triaged patients, and under triaged patients leads to efficiency in cost and care for trauma patients.
Design: The trauma services department meets annually with ED leadership to evaluate the trauma criteria. After thorough review of trauma registry data and recent evidence-based research, adjustments are made to reflect current practice and best utilization of resources.
Setting: A 408 bed metropolitan Level 1 trauma center, with over 2600 trauma admissions per year.
Participants/Subjects: Emergency department nursing staff (n=82) with a focus on the charge nurses; all trauma patients meeting level 1 and level 2 trauma criteria entering through the emergency department between July 2017 and November 2018 (n=1215).
Methods: At the end of 2017 significant changes were made to the trauma criteria to more accurately reflect our trauma populations. Changes included stable trauma transfer patients moved to level 2, high energy impact as the focus for motor vehicle crashes and recreational injuries, and removing rollover and death in same car were as evidence showed that less injuries are being seen with safer vehicle construction. These changes were implemented in January 2018. Our under/over triage statistics improved, but there was additional opportunity for improvement. By March of 2018, we identified a large number of our level 2 patients were discharged from the ED. We reviewed feedback from the EMS community regarding the large number of level 2 alerts being called on patients without significant injuries. With additional review of research and data, we modified our level 2 criteria. Each modification required intensive education to the ED staff, focusing on charge nurses and triage nurses, the first contact for incoming trauma patients. Training included listening and discussing challenging EMS calls to help identify the appropriate activation and utilization of resources. July 2018 the current criteria was implemented.
Results/Outcomes: The biggest change was noted to be in the level 2 trauma patients. During the period between July 2017 to June 2018 the mean admission rate for patients meeting the level 2 trauma criteria was 35%. After implementing changes to the trauma criteria, July 2018 to November 2018, the mean admission rate for patients meeting the level 2 trauma criteria increased to 63%. There was no significant change in the admission rates for the level 1 trauma criteria patients.
Implications: Under/over triage is truly about resource utilization. In July of 2018 after implementing new criteria, we achieved our goal of appropriately activating trauma resources for the correct patients. Multiple benefits arise from reevaluating trauma criteria on a regular basis: Utilization of hospital resources are more appropriate, the patient avoids unnecessary hospital costs, increased patient satisfaction and improved EMS support without having a negative effect on patient care.
DescriptionEmergency Nursing 2019. Held at the Austin Convention Center, Austin, Texas, USA
Conference NameEmergency Nursing 2019
Conference HostEmergency Nurses Association
Conference LocationAustin, Texas, USA
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