How can major trauma units be run more efficiently and cost-effectively?

Major trauma is a serious injury that can result in death or disability. It is the leading cause of death for people under the age of 45 in England, and the fourth leading cause of death overall. Major trauma can be caused by various events, such as road traffic crashes, falls, violence, or natural disasters. Major trauma units are specialized hospitals that provide comprehensive and multidisciplinary care for patients with major trauma. They are part of regional trauma networks that coordinate the delivery of trauma services across different levels of care.

Major trauma units play a vital role in saving lives and improving outcomes for patients with major trauma. However, they also face various challenges and pressures, such as high demand, limited resources, complex logistics, and quality standards. How can major trauma units be run more efficiently and cost-effectively, without compromising the quality and safety of care? In this article, we will explore some of the possible strategies and solutions, based on the evidence and experience from different sources.

Pre-hospital triage and transfer

One of the key factors that affect the efficiency and cost-effectiveness of major trauma units is the pre-hospital triage and transfer of patients. Pre-hospital triage is the process of identifying and prioritizing patients who need urgent and specialized care at a major trauma unit and diverting those who can be treated at a lower level of care. Pre-hospital transfer is the process of transporting patients to the appropriate destination, as quickly and safely as possible.

Pre-hospital triage and transfer can improve the efficiency and cost-effectiveness of major trauma units by reducing the overtriage and undertriage rates and optimizing the use of resources and capacity. Overtriage occurs when patients who do not need major trauma unit care are taken there, resulting in unnecessary costs and crowding. Undertriage occurs when patients who need major trauma unit care are taken elsewhere, resulting in delayed or inadequate care and worse outcomes. Both overtriage and undertriage can have negative consequences for patients, providers, and the system.

To improve the pre-hospital triage and transfer of patients with major trauma, some of the possible strategies and solutions are:

  • Providing a pre-hospital major trauma triage tool that can differentiate between patients who need major trauma unit care and those who do not, based on the assessment of physiology, anatomy, mechanism, and special factors.
  • Supporting pre-hospital care providers with immediate clinical advice from the ambulance control center, and providing them with training and feedback on the use of the triage tool.
  • Establishing clear and standardized protocols and pathways for the pre-hospital transfer of patients with major trauma, and ensuring the availability and coordination of transport resources and communication systems.
  • Spending only enough time at the scene to provide immediate life-saving interventions, and minimizing the on-scene and transport times.
  • Diverting patients who need life-saving interventions that cannot be delivered by the pre-hospital team to the nearest trauma unit, and arranging for secondary transfer to a major trauma unit if needed.

Hospital organization and management

Another factor that affects the efficiency and cost-effectiveness of major trauma units is the hospital organization and management of trauma services. Hospital organization and management refers to the structure, processes, and systems that support the delivery of trauma care within the hospital. It includes aspects such as leadership, governance, staffing, equipment, facilities, protocols, pathways, documentation, monitoring, and audit.

Hospital organization and management can improve the efficiency and cost-effectiveness of major trauma units by enhancing the quality and consistency of care, reducing variability and waste, and improving the performance and outcomes. Quality and consistency of care can be improved by ensuring that patients with major trauma receive timely and appropriate interventions, based on the best available evidence and standards. Variability and waste can be reduced by eliminating unnecessary or inappropriate tests, treatments, or transfers, and optimizing the use of resources and capacity. Performance and outcomes can be improved by measuring and monitoring the processes and results of trauma care and implementing quality improvement initiatives and feedback mechanisms.

To improve the hospital organization and management of trauma services, some of the possible strategies and solutions are:

  • Developing and implementing a clear and comprehensive trauma service plan, that defines the vision, mission, goals, objectives, and strategies of the trauma service, and aligns them with the regional trauma network and the hospital strategic plan.
  • Establishing and empowering a multidisciplinary trauma team, that includes representatives from all the relevant clinical and non-clinical disciplines and departments, and assigns clear roles and responsibilities for the coordination and delivery of trauma care.
  • Providing adequate and appropriate staffing, equipment, and facilities for the trauma service, and ensuring their availability and accessibility at all times.
  • Developing and implementing standardized and evidence-based protocols and pathways for the assessment, resuscitation, stabilization, investigation, management, and transfer of patients with major trauma, and ensuring their compliance and adherence.
  • Developing and implementing a comprehensive and consistent documentation system for the trauma service, that captures and records all the relevant data and information on the processes and outcomes of trauma care, and facilitates communication and handover.
  • Developing and implementing a robust and regular monitoring and audit system for the trauma service, that collects and analyzes the data and information on the performance and outcomes of trauma care, and identifies and addresses the gaps and areas for improvement.

Information and support for patients and families

A third factor that affects the efficiency and cost-effectiveness of major trauma units is the information and support provided to patients and families. Information and support refers to the communication, education, and assistance that are offered to patients and families throughout the trauma care continuum, from the pre-hospital to the post-discharge phase. It includes aspects such as informed consent, confidentiality, privacy, feedback, complaints, and satisfaction.

Information and support can improve the efficiency and cost-effectiveness of major trauma units by enhancing the patient and family experience, engagement, and empowerment, and reducing the adverse events, complications, and litigation. Patient and family experience can be enhanced by providing clear, accurate, timely, and empathetic information and support, and addressing their needs and expectations. Patient and family engagement and empowerment can be enhanced by involving them in decision-making and care planning and respecting their preferences and values. Adverse events, complications, and litigation can be reduced by preventing or managing the potential risks and harms and resolving the issues and concerns.

To improve the information and support provided to patients and families, some of the possible strategies and solutions are:

Conclusion

Major trauma units are essential for providing life-saving and life-improving care for patients with major trauma. However, they also face various challenges and pressures, such as high demand, limited resources, complex logistics, and quality standards. To run more efficiently and cost-effectively, major trauma units need to implement and evaluate various strategies and solutions, based on the evidence and experience from different sources. Some of the possible strategies and solutions are:

  • Improving the pre-hospital triage and transfer of patients with major trauma, by using a validated triage tool, providing clinical advice, establishing clear protocols and pathways, minimizing the scene and transport times, and diverting patients who need intermediate care.
  • Improving the hospital organization and management of trauma services, by developing and implementing a trauma service plan, establishing and empowering a multidisciplinary trauma team, providing adequate and appropriate staffing, equipment, and facilities, developing and implementing standardized and evidence-based protocols and pathways, developing and implementing a comprehensive and consistent documentation system, and developing and implementing a robust and regular monitoring and audit system.
  • Improving the information and support provided to patients and families, by providing a designated and trained liaison person, providing a written and verbal information pack, providing regular and frequent updates and feedback, providing opportunities and channels for questions, opinions, concerns, or complaints, providing emotional and psychological support, and providing practical and financial support.

By implementing and evaluating these strategies and solutions, major trauma units can improve their efficiency and cost-effectiveness, without compromising the quality and safety of care. This can benefit not only the patients and families, but also the providers and the system, and ultimately, the society and the economy.

List of Facts and Figures Related to Major Trauma

  • Major trauma is a serious injury that can result in death or disability. It is the leading cause of death for people under the age of 45 in England, and the fourth leading cause of death overall.
  • Major trauma has significant economic and social costs, estimated at £3.3 billion per year in England, and £41 billion per year in the US.
  • Major trauma patients have a high risk of developing complications, such as infections, bleeding, organ failure, or psychological distress, which can increase the length of stay, the cost of care, and mortality and morbidity.
  • Major trauma patients have a high need for rehabilitation and long-term care, as many of them suffer from permanent impairments, disabilities, or reduced quality of life.
  • Major trauma care has improved significantly in the past decade, with the introduction of regional trauma networks, major trauma units, and trauma teams, which have reduced the mortality and morbidity of major trauma patients by 20-30%.
  • Major trauma care is still evolving and innovating, with the development of new technologies, techniques, and treatments, such as pre-hospital blood transfusion, damage control surgery, or telemedicine, which can further improve the outcomes and efficiency of major trauma care.