Evaluation of the Implementation of the Trauma Triage and Destination Plan on the Field Triage of Injured Patients in North Carolina

Jane H. Brice, Frances S. Shofer, Christopher Cowden, E. Brooke Lerner, Matthew Psioda, Meredith Arasaratanam, N. Clay Mann, Antonio R. Fernandez, Anna Waller, Chailee Moss, Michael Mian

Research output: Contribution to journalArticle

Abstract

Objective: Timely triage and appropriate destination decision making for injured patients are central challenges faced by emergency medical services (EMS) systems. In 2010, North Carolina (NC) adopted a statewide Trauma Triage and Destination Plan (TTDP) based on the CDC's Field Triage Guidelines to better address these challenges. We sought to characterize the implementation of these guidelines by quantifying their effect on multiple metrics of patient care. Methods: We employed a retrospective pre-post study design utilizing a statewide EMS medical record database. We assessed several metrics of patient care—including changes in destination choice, appropriateness of EMS destination, transit time to first hospital, transit time to definitive care, and others—in a six-month period in the year before and after the implementation of the guidelines. Results: We evaluated a total of 190,307 EMS encounters pre- (n = 93,927) and post-implementation (n = 96,380). Among all patients, there was not a significant difference in the percentage transported to a community hospital or Level I, II, or III trauma center as their first destination. Among those patients meeting TTDP guidelines for transport to a trauma center, the number transported to a Level I or II trauma center decreased 1.0% from 30.6% (n = 2,911) to 29.6% (n = 2,954) (95% CI: −0.2%, 2.2%). Those transported to a Level I trauma center decreased 0.4% from 21.2% to 20.8% in the post-period (95% CI: −0.7%, 1.5%). There were also no significant changes in EMS scene times (14.0 pre-, 14.1 post-) and transport times (12.9 pre-, 13.0 post-). While scene distance from a Level I trauma center showed a decreased likelihood of transport to that center, there was an overall post-implementation increase of 2.5% from 18.0% to 20.5% (95% CI: −3.6%, −1.3%) in transport to a Level I trauma center among patients meeting anatomic criteria across all distance ranges. Conclusions: We found that implementation of region-specific destination plans based on the Field Triage Guidelines had little effect on selected hospital destination, scene times, transport times, and other metrics of EMS decision making and effectiveness. We suspect this is due to delays in information dissemination and adoption by field providers.

Original languageEnglish (US)
Pages (from-to)591-604
Number of pages14
JournalPrehospital Emergency Care
Volume21
Issue number5
DOIs
StatePublished - Sep 3 2017
Externally publishedYes

Fingerprint

Triage
Trauma Centers
Emergency Medical Services
Guidelines
Wounds and Injuries
Information Dissemination
Community Hospital
Centers for Disease Control and Prevention (U.S.)
Medical Records
Decision Making
Patient Care
Databases

Keywords

  • emergency medical services
  • emergency medicine
  • outcome assessment (health care)
  • transportation of patients
  • trauma centers
  • triage

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Evaluation of the Implementation of the Trauma Triage and Destination Plan on the Field Triage of Injured Patients in North Carolina. / Brice, Jane H.; Shofer, Frances S.; Cowden, Christopher; Lerner, E. Brooke; Psioda, Matthew; Arasaratanam, Meredith; Mann, N. Clay; Fernandez, Antonio R.; Waller, Anna; Moss, Chailee; Mian, Michael.

In: Prehospital Emergency Care, Vol. 21, No. 5, 03.09.2017, p. 591-604.

Research output: Contribution to journalArticle

Brice, JH, Shofer, FS, Cowden, C, Lerner, EB, Psioda, M, Arasaratanam, M, Mann, NC, Fernandez, AR, Waller, A, Moss, C & Mian, M 2017, 'Evaluation of the Implementation of the Trauma Triage and Destination Plan on the Field Triage of Injured Patients in North Carolina', Prehospital Emergency Care, vol. 21, no. 5, pp. 591-604. https://doi.org/10.1080/10903127.2017.1308606
Brice, Jane H. ; Shofer, Frances S. ; Cowden, Christopher ; Lerner, E. Brooke ; Psioda, Matthew ; Arasaratanam, Meredith ; Mann, N. Clay ; Fernandez, Antonio R. ; Waller, Anna ; Moss, Chailee ; Mian, Michael. / Evaluation of the Implementation of the Trauma Triage and Destination Plan on the Field Triage of Injured Patients in North Carolina. In: Prehospital Emergency Care. 2017 ; Vol. 21, No. 5. pp. 591-604.
@article{3f986c1e0d3c4129a661bfdcc627177c,
title = "Evaluation of the Implementation of the Trauma Triage and Destination Plan on the Field Triage of Injured Patients in North Carolina",
abstract = "Objective: Timely triage and appropriate destination decision making for injured patients are central challenges faced by emergency medical services (EMS) systems. In 2010, North Carolina (NC) adopted a statewide Trauma Triage and Destination Plan (TTDP) based on the CDC's Field Triage Guidelines to better address these challenges. We sought to characterize the implementation of these guidelines by quantifying their effect on multiple metrics of patient care. Methods: We employed a retrospective pre-post study design utilizing a statewide EMS medical record database. We assessed several metrics of patient care—including changes in destination choice, appropriateness of EMS destination, transit time to first hospital, transit time to definitive care, and others—in a six-month period in the year before and after the implementation of the guidelines. Results: We evaluated a total of 190,307 EMS encounters pre- (n = 93,927) and post-implementation (n = 96,380). Among all patients, there was not a significant difference in the percentage transported to a community hospital or Level I, II, or III trauma center as their first destination. Among those patients meeting TTDP guidelines for transport to a trauma center, the number transported to a Level I or II trauma center decreased 1.0{\%} from 30.6{\%} (n = 2,911) to 29.6{\%} (n = 2,954) (95{\%} CI: −0.2{\%}, 2.2{\%}). Those transported to a Level I trauma center decreased 0.4{\%} from 21.2{\%} to 20.8{\%} in the post-period (95{\%} CI: −0.7{\%}, 1.5{\%}). There were also no significant changes in EMS scene times (14.0 pre-, 14.1 post-) and transport times (12.9 pre-, 13.0 post-). While scene distance from a Level I trauma center showed a decreased likelihood of transport to that center, there was an overall post-implementation increase of 2.5{\%} from 18.0{\%} to 20.5{\%} (95{\%} CI: −3.6{\%}, −1.3{\%}) in transport to a Level I trauma center among patients meeting anatomic criteria across all distance ranges. Conclusions: We found that implementation of region-specific destination plans based on the Field Triage Guidelines had little effect on selected hospital destination, scene times, transport times, and other metrics of EMS decision making and effectiveness. We suspect this is due to delays in information dissemination and adoption by field providers.",
keywords = "emergency medical services, emergency medicine, outcome assessment (health care), transportation of patients, trauma centers, triage",
author = "Brice, {Jane H.} and Shofer, {Frances S.} and Christopher Cowden and Lerner, {E. Brooke} and Matthew Psioda and Meredith Arasaratanam and Mann, {N. Clay} and Fernandez, {Antonio R.} and Anna Waller and Chailee Moss and Michael Mian",
year = "2017",
month = "9",
day = "3",
doi = "10.1080/10903127.2017.1308606",
language = "English (US)",
volume = "21",
pages = "591--604",
journal = "Prehospital Emergency Care",
issn = "1090-3127",
publisher = "Informa Healthcare",
number = "5",

}

TY - JOUR

T1 - Evaluation of the Implementation of the Trauma Triage and Destination Plan on the Field Triage of Injured Patients in North Carolina

AU - Brice, Jane H.

AU - Shofer, Frances S.

AU - Cowden, Christopher

AU - Lerner, E. Brooke

AU - Psioda, Matthew

AU - Arasaratanam, Meredith

AU - Mann, N. Clay

AU - Fernandez, Antonio R.

AU - Waller, Anna

AU - Moss, Chailee

AU - Mian, Michael

PY - 2017/9/3

Y1 - 2017/9/3

N2 - Objective: Timely triage and appropriate destination decision making for injured patients are central challenges faced by emergency medical services (EMS) systems. In 2010, North Carolina (NC) adopted a statewide Trauma Triage and Destination Plan (TTDP) based on the CDC's Field Triage Guidelines to better address these challenges. We sought to characterize the implementation of these guidelines by quantifying their effect on multiple metrics of patient care. Methods: We employed a retrospective pre-post study design utilizing a statewide EMS medical record database. We assessed several metrics of patient care—including changes in destination choice, appropriateness of EMS destination, transit time to first hospital, transit time to definitive care, and others—in a six-month period in the year before and after the implementation of the guidelines. Results: We evaluated a total of 190,307 EMS encounters pre- (n = 93,927) and post-implementation (n = 96,380). Among all patients, there was not a significant difference in the percentage transported to a community hospital or Level I, II, or III trauma center as their first destination. Among those patients meeting TTDP guidelines for transport to a trauma center, the number transported to a Level I or II trauma center decreased 1.0% from 30.6% (n = 2,911) to 29.6% (n = 2,954) (95% CI: −0.2%, 2.2%). Those transported to a Level I trauma center decreased 0.4% from 21.2% to 20.8% in the post-period (95% CI: −0.7%, 1.5%). There were also no significant changes in EMS scene times (14.0 pre-, 14.1 post-) and transport times (12.9 pre-, 13.0 post-). While scene distance from a Level I trauma center showed a decreased likelihood of transport to that center, there was an overall post-implementation increase of 2.5% from 18.0% to 20.5% (95% CI: −3.6%, −1.3%) in transport to a Level I trauma center among patients meeting anatomic criteria across all distance ranges. Conclusions: We found that implementation of region-specific destination plans based on the Field Triage Guidelines had little effect on selected hospital destination, scene times, transport times, and other metrics of EMS decision making and effectiveness. We suspect this is due to delays in information dissemination and adoption by field providers.

AB - Objective: Timely triage and appropriate destination decision making for injured patients are central challenges faced by emergency medical services (EMS) systems. In 2010, North Carolina (NC) adopted a statewide Trauma Triage and Destination Plan (TTDP) based on the CDC's Field Triage Guidelines to better address these challenges. We sought to characterize the implementation of these guidelines by quantifying their effect on multiple metrics of patient care. Methods: We employed a retrospective pre-post study design utilizing a statewide EMS medical record database. We assessed several metrics of patient care—including changes in destination choice, appropriateness of EMS destination, transit time to first hospital, transit time to definitive care, and others—in a six-month period in the year before and after the implementation of the guidelines. Results: We evaluated a total of 190,307 EMS encounters pre- (n = 93,927) and post-implementation (n = 96,380). Among all patients, there was not a significant difference in the percentage transported to a community hospital or Level I, II, or III trauma center as their first destination. Among those patients meeting TTDP guidelines for transport to a trauma center, the number transported to a Level I or II trauma center decreased 1.0% from 30.6% (n = 2,911) to 29.6% (n = 2,954) (95% CI: −0.2%, 2.2%). Those transported to a Level I trauma center decreased 0.4% from 21.2% to 20.8% in the post-period (95% CI: −0.7%, 1.5%). There were also no significant changes in EMS scene times (14.0 pre-, 14.1 post-) and transport times (12.9 pre-, 13.0 post-). While scene distance from a Level I trauma center showed a decreased likelihood of transport to that center, there was an overall post-implementation increase of 2.5% from 18.0% to 20.5% (95% CI: −3.6%, −1.3%) in transport to a Level I trauma center among patients meeting anatomic criteria across all distance ranges. Conclusions: We found that implementation of region-specific destination plans based on the Field Triage Guidelines had little effect on selected hospital destination, scene times, transport times, and other metrics of EMS decision making and effectiveness. We suspect this is due to delays in information dissemination and adoption by field providers.

KW - emergency medical services

KW - emergency medicine

KW - outcome assessment (health care)

KW - transportation of patients

KW - trauma centers

KW - triage

UR - http://www.scopus.com/inward/record.url?scp=85017572992&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017572992&partnerID=8YFLogxK

U2 - 10.1080/10903127.2017.1308606

DO - 10.1080/10903127.2017.1308606

M3 - Article

C2 - 28422541

AN - SCOPUS:85017572992

VL - 21

SP - 591

EP - 604

JO - Prehospital Emergency Care

JF - Prehospital Emergency Care

SN - 1090-3127

IS - 5

ER -