Effectiveness of a 2-Specialty, 2-Tiered Triage and Trauma Team Activation Protocol

An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre

“…Surgical and anaesthetic staff must suspend theatre lists, clinics and ward rounds to respond to the ED for an unpredictable amount of time. Plaisier et al 3 quantified the financial cost of this disruption in an American MTC in 1998. In their institution, the introduction of a two-tiered system saved around 578 physician hours during the 6-month study period, which equated to savings of around £400 000 per annum.…”

“…Outcome from traumatic injury can be optimised by the appropriate activation of a multidisciplinary trauma team to receive the patient on arrival at hospital, reducing time to effective diagnosis and intervention, influencing both morbidity and mortality 2. In a major trauma centre (MTC), in addition to seriously injured patients, a large number of less severely injured patients may also need to be treated 3. As activation of trauma teams is time and labour intensive, it is essential that resources are appropriately used.…”

The Efficacy of a Two-Tiered Trauma Activation System at a Level I Trauma Center

“…However, limiting personnel time and resources clearly provides more efficient and less expensive care. Plaiser et al 19 estimated that 578 physician hours would be saved every 6 months by instituting their two-tiered system. Other studies have provided information on precise cost savings by instituting a differential trauma team activation system.…”

A leap in faith: the impact of removing the surgeon from the level II trauma response

“…The safe implementation of a 2-specialty, 2-tiered response protocols has been reported by several adult trauma centers, with substantial cost savings [4][5][6][7][8]. Tinkoff et al [8] reported their protocol in which the level II response (btrauma alertsQ) was initially handled by the ED physicians, although surgeons continued to respond immediately to the level I trauma activations (btrauma codesQ).…”

“…This resulted in a significant reduction in mean ED LOS with no adverse outcomes. Plaisier et al [7] reported a similar protocol, with the notable exception that ED physicians obtained a mandatory surgery consultation for every Level II patient after initial assessment and resuscitation. Although the authors estimated savings of 578 physician-hours of time for the trauma service over the 6-month study period, there were 3 deaths among the level II patients (mortality 1%).…”