Reducing "cry wolf"--changing trauma team activation at a pediatric trauma centre.

BACKGROUND: To improve utilization of scarce surgical resources, we changed from a single tier trauma paging system (TPS) to a three tiered TPS at a tertiary pediatric trauma center. We investigated if patients were appropriately classified into the three levels of trauma team activation.
METHODS: Trauma registry data were used to review data 12 months before and after implementation of a three tiered TPS (level I entire team present, level II surgical subspecialties within 10 minutes, level III emergency department team only at patient arrival). We correlated TPS activation with proxies of injury severity (admission status and major/nonmajor trauma).
RESULTS: There were 192 activations during 12 months of the single tier TPS and 216 during the three tier TPS (33 level I, 49 level II, and 134 level III). The entire team was to attend in all 192 single tier and in 82 (40%) level I and II three tier TPS activations i.e., there were 60% fewer surgical team activations. During single tier TPS, 96% patients were admitted and 23% classified as major trauma. Three tiered TPS level I, II and III were admitted in 97%, 94%, and 81% and classified as major trauma in 58%, 35%, and 15%, respectively. Of the 20 level III patients classified as major trauma, TPS level was deemed appropriate in 18 and inappropriately low in 2, although patient care had not been compromised.
CONCLUSION: Our results suggest that a three tiered TPS more efficiently utilizes limited surgical resources without leading to major misclassifications.