Impact of a Two-Tiered Trauma Response in the Emergency Department

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Abstract
The purpose of this prospective study was to assess the impact of a two-tiered trauma response protocol on the expediency of identification, evaluation, and treatment of trauma patients in the Emergency Department. At a Level I Trauma Center serving a suburban/urban population of approximately one million people, Emergency Department length of stay was tabulated for all consecutive Trauma Service admissions 6 months before and 6 months after implementation of a two-tiered trauma response protocol. This protocol, which uses specific triage criteria, consisted of the standard Surgery-supervised trauma code response and an additional Emergency Medicine-supervised trauma alert response. Trauma Service admissions numbered 532 in the pre-protocol period and 512 in the period after implementation of the protocol. In the first period, the Emergency Department length of stay was 289 minutes; in the second period, it was 241 minutes. Of the 512 patients in the post-protocol period, 183 were triaged to the new trauma alert group, reducing the number of Trauma Service consultations and decreasing Emergency Department length of stay by 139 minutes. The two levels of trauma response allowed accurate identification of the most seriously injured patients and improved the ability to predict those patients who would require direct disposition to the operating room or intensive care unit. Implementation of a two-tiered trauma response significantly decreased Emergency Department length of stay, allowed Emergency Medicine physicians to more rapidly identify, evaluate, and treat trauma patients requiring hospitalization, improved identification of patients requiring operating room or intensive care unit resources, and was time efficient and resource efficient.

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