Emergency management of multiple trauma patients in a level i trauma center: "Time" as a quality assurance

Abstract

Background: We aimed to find out the present level of trauma care in our ED by evaluating time to determine standards of our trauma care and compare these standards with advanced trauma centers.Methods: Between January 2002 and May 2002, 104 multiple trauma patients (age > 15) bearing criterias for trauma team activation in advanced trauma life support (ATLS) protocols were randomly included in the study. Time needed to perform the routine trauma x-rays (lateral cervical vertabra, AP chest, AP pelvis radiographies), abdominal ultrasonography (USG), laboratory tests, if indicated cranial computerized tomography (CCT) and the length of stay (LOS) in the ED were recorded.Results: Patients who needed emergency surgery were taken to the operation room within 30 minutes compatible with objective time of advanced trauma centers. The x-rays, abdominal USG, laboratory tests of all patients and CCT if required were performed within mean 47 +/- 20 minutes, 56 +/- 27 minutes, 91 +/- 23,5 minutes and 98 +/- 30 minutes, respectively. The average LOS in the ED was 162 +/- 87 minutes.Conclusion: As a result, total ED stay of a multiple trauma patient in our ED was found to be significantly longer when compared to that of advanced centers. In constant quality improvement, assessment of structural features and the methods used, on the basis of lost time is a parameter that is important but not sufficient.