These results suggest that previous studies failed to support the "golden hour" not due to a lack of patients significantly impacted by prehospital time within their trauma populations, but instead due to limitations in their efforts to account for patient acuity. As a result, these studies inappropriately rejected the "golden hour," leading to the current disagreement in literature regarding the relationship between prehospital time and trauma patient mortality. The Relative Mortality Analysis was shown to overcome the limitations of these studies and demonstrated that the "golden hour" was significant for patients who were not low acuity (PoS >91%) or severely high acuity (PoS <23%).

Measurement of trauma center performance presently relies on W-score calculation and comparison to national data sets. A limitation to this practice is a skewing of the W score, as it determines overall performance of a trauma population that is often heavily weighted by patients of low acuity. The University of Virginia relative mortality metric (RMM) was formulated to provide higher resolution in identifying areas of performance improvement within subpopulations of a trauma center using traditional Trauma Injury Severity Score methodology. Lactic acidosis has been established as a risk factor for mortality in the setting of trauma. This study aims to compare survival margin, defined as the area between actual and predicted mortality curves, in patients with either normal or elevated initial lactate. W score and RMM were calculated and compared in these cohorts. Whereas the W score suggested increased survival within the high initial lactate group, the RMM demonstrated the expected finding of increased survival margin in the normal lactate cohort. The RMM is a potentially valuable tool for trauma centers to monitor and improve performance. In addition, these findings validate the use of lactate as a triage and risk adjustment tool in the trauma setting.

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For decades, emergency departments have become increasingly unable to meet escalating patient demands. In order to allow emergency departments to operate beyond their designed capacity, major efforts have gone into improving their work-flow, efficiency, and quality of care. Many studies have show that inefficiencies and error in a clinical setting are linked to communications. As a means to improve the quality of care for trauma patients, this study examines the present communication systems for different admission pathways to the University of Virginia’s Surgical Intensive Care Unit (SICU) and recommends a new design for critical operations. The evaluation and analysis of this new design will identify critical factors, including potential communication modalities, implementation details, potential key clinician roles, and in which processes the new system will be useful. Our objective is to design a real-time communication infrastructure for operations within a critical care unit by an informed design process.