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The effectiveness of a statewide trauma call center in reducing time to definitive care for severely injured patients

Porter, Austin MPH; Wyrick, Deidre MD; Bowman, Stephen M. PhD; Recicar, John MBA; Maxson, Robert Todd MD

Journal of Trauma and Acute Care Surgery:
doi: 10.1097/TA.0000000000000142
AAST Plenary Papers
Editor's Choice
Abstract

BACKGROUND: The state of Arkansas developed and implemented a comprehensive inclusive trauma system in July 2010. The Arkansas Trauma Communication Center (ATCC) is a central component in the system, designed to facilitate both scene transports and interfacility transfers within the state. The first 18 months of operations were examined to evaluate the relationship between ATCC use and emergency department (ED) length of stay (LOS) at sending facilities for patients who require urgent care.

METHODS: ATCC data were linked to the Arkansas Trauma Registry using unique identifiers. Patients younger than 15 years were excluded from the analysis. Patients older than 15 years with significant injury requiring interfacility transfer were the study population. Significant injury was defined as those with hypotension (systolic blood pressure < 90 mm Hg) or Glasgow Coma Scale (GCS) score less than 9 at the sending facility or Injury Severity Score (ISS) of 16 or greater at the definitive care facility. This cohort was stratified by the use of the ATCC, and ED LOS was determined.

RESULTS: The study population who met the inclusion criteria was 856; 632 (74%) of whom used the ATCC and 224 (26%) did not use the ATCC for interfacility transfers. There were no statistically significant differences noted between these two groups regarding ISS, systolic blood pressure, and GCS score. The ATCC was associated with a 21-minute reduction in the ED LOS at the sending facility when controlling for all other factors. (p = 0.005).

CONCLUSION: In the first 18 months following inception, the ATCC has been effective in expediting the transfer process and thus reducing the time to definitive care for severely injured patients. ATCC use has improved since inception and is now a contract deliverable for trauma hospitals based on these early results.

LEVEL OF EVIDENCE: Therapeutic study, level III.

Author Information

From the Arkansas Department of Health (A.P.); and Arkansas Children’s Hospital (D.W., J.R., R.T.M.) Little Rock, Arkansas; and Fay W. Boozman College of Public Health (S.M.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Submitted: September 5, 2013, Revised: November 18, 2013, Accepted: November 21, 2013.

This study was presented at the 72nd annual meeting of the American Association for the Surgery of Trauma, September 18–21, 2013, in San Francisco, California.

Address for reprints: Austin Porter, MPH, Arkansas Department of Health, 4815 West Markham, Little Rock, AR 72205; email: Austin.Porter@arkansas.gov.

© 2014 Lippincott Williams & Wilkins, Inc.