R B Fisher1, C H Dearden. 1. Accident and Emergency Department, Royal Victoria Hospital, Belfast.
Abstract
OBJECTIVE: To determine whether improvement in the care of victims of major trauma could be made by using the revised trauma score as a triage tool to help junior accident and emergency doctors rapidly identify seriously injured patients and thereby call a senior accident and emergency specialist to supervise their resuscitation. DESIGN: Comparison of results of audit of management of all seriously injured patients before and after these measures were introduced. SETTING: Accident and emergency department in an urban hospital. PATIENTS: All seriously injured patients (injury severity score greater than 15) admitted to the department six months before and one year after introduction of the measures. RESULTS: Management errors were reduced from 58% (21/36) to 30% (16/54) (p less than 0.01). Correct treatment rather than improvement in diagnosis or investigation accounted for almost all the improvement. CONCLUSIONS: The management of seriously injured patients in the accident and emergency department can be improved by introducing two simple measures: using the revised trauma score as a triage tool to help junior doctors in the accident and emergency department rapidly identify seriously injured patients, and calling a senior accident and emergency specialist to supervise the resuscitation of all seriously injured patients. IMPLICATIONS: Care of patients in accident and emergency departments can be improved considerably at no additional expense by introducing two simple measures.
OBJECTIVE: To determine whether improvement in the care of victims of major trauma could be made by using the revised trauma score as a triage tool to help junior accident and emergency doctors rapidly identify seriously injured patients and thereby call a senior accident and emergency specialist to supervise their resuscitation. DESIGN: Comparison of results of audit of management of all seriously injured patients before and after these measures were introduced. SETTING: Accident and emergency department in an urban hospital. PATIENTS: All seriously injured patients (injury severity score greater than 15) admitted to the department six months before and one year after introduction of the measures. RESULTS: Management errors were reduced from 58% (21/36) to 30% (16/54) (p less than 0.01). Correct treatment rather than improvement in diagnosis or investigation accounted for almost all the improvement. CONCLUSIONS: The management of seriously injured patients in the accident and emergency department can be improved by introducing two simple measures: using the revised trauma score as a triage tool to help junior doctors in the accident and emergency department rapidly identify seriously injured patients, and calling a senior accident and emergency specialist to supervise the resuscitation of all seriously injured patients. IMPLICATIONS: Care of patients in accident and emergency departments can be improved considerably at no additional expense by introducing two simple measures.
Authors: Angela Lashoher; Eric B Schneider; Catherine Juillard; Kent Stevens; Elizabeth Colantuoni; William R Berry; Christina Bloem; Witaya Chadbunchachai; Satish Dharap; Sydney M Dy; Gerald Dziekan; Russell L Gruen; Jaymie A Henry; Christina Huwer; Manjul Joshipura; Edward Kelley; Etienne Krug; Vineet Kumar; Patrick Kyamanywa; Alain Chichom Mefire; Marcos Musafir; Avery B Nathens; Edouard Ngendahayo; Thai Son Nguyen; Nobhojit Roy; Peter J Pronovost; Irum Qumar Khan; Junaid Abdul Razzak; Andrés M Rubiano; James A Turner; Mathew Varghese; Rimma Zakirova; Charles Mock Journal: World J Surg Date: 2017-04 Impact factor: 3.352