Impact of Trauma Volume on Emergency Department Throughput, as Seen by CT Scan Completion Times

For decades, it has been accepted that trauma patients should be seen within the “Golden Hour,” the 1st hour after the onset of the out-of-hospital trauma, to reduce morbidity and mortality through early intervention.1 Although some contemporary studies have challenged the benefit of the Golden Hour, the literature has shown that for a severely injured patient, treatment from a Level I trauma center can help reduce mortality by up to 25 per cent.2 Most, if not all, trauma I centers give early treatment of trauma patients within the ED because of an increasing length of time before a critical care bed becomes available.3 Because issues of hospital overcrowding increase, the wait for critical care beds attributes to increased length of stay. Research has shown that increased trauma patient length of stay in the ED is associated with a higher 30day mortality rate in other patients.4 Mowery et al.3 evaluated the impact of ED length of stay on hospital mortality and showed through linear regression that a longer ED length of stay is associated with increased hospital mortality. Throughout the country, many hospitals are presently struggling with increasing ED length of stay of trauma patients. Both ED physicians and trauma surgeons have sought after solutions to reduce overcrowding in the ED. By investigating the effects on ED throughput because of trauma activations, the impact on hospital mortality can be further examined. This study measures the exact empiric delay caused on ED throughput with each trauma activation; we wanted to see if the ED grinds to a “halt” to measure if resources are taken from ED patients by trauma activations. This retrospective, observational study uses information from Navicent Health’s database. Navicent Health, formerly the Medical Center of Central Georgia, is the second largest hospital in Georgia; it operates 637 beds across specialties and is a Level I urban trauma center. The Emergency Medical Services of Navicent Health serve Baldwin, Bibb, Jones, and Twiggs counties. Trauma patients throughout central Georgia (a region of about 30 counties) can be life-flighted to Navicent Health. We reviewed all (n 4 1647) level I and level II trauma cases admitted to the ED during the span of one year (January 1, 2015, through December 31, 2015). We excluded trauma patients who entered the operation room immediately on arrival because they did not use the ED’s resources before going straight to surgery. Patients who had a CT scan before the orders were placed were excluded because the CT examination completion time then became a negative number. Our specific trauma center’s standard protocol for activation of the full trauma team defined each trauma as level I, level II, or a transfer (Table 1). In general, level I activations involve majorly injured or critical trauma patients. Level II activations are generally termed “urgent” but are less critically injured than level I activations. A transfer, also called a level III activation, is generally a trauma evaluation or consult. Transfers were excluded from this study because they activated the least amount of personnel and resources from the ED and were not the primary concern for possibly driving the ED to a “halt. ” We categorized patients based on their arrival times and by splitting a 24-hour day into 30-minute windows. We chose this window to give us an interval of time to measure the effect of trauma patients on CT scan examination completion times. Radiological examination completion was defined as the amount of time taken to process an order for a CT scan to a completed examination with the images ready to be read by a radiologist. The primary outcome looked at the impact of trauma activations on radiological examination completion time. We defined the time to be from when the order was entered to when the CT images were ready for review. Regression analysis was used to assess for correlations among trauma patient volume, radiological examination completion time, radiology examination Address correspondence and reprint requests to Ramupriya Vaithi, B.A., Medical Student, Mercer University School of Medicine, 200 Charter Lane, Apt 307, Macon, GA 31210. E-mail: priya.vaithi22@gmail.com.