The Red Blanket Protocol in a tertiary centre in Aotearoa New Zealand: does this trauma protocol improve time to surgery and clinical outcomes?

Abstract

Background: Patients who are haemodynamically unstable from surgical emergencies require prompt surgical intervention, and delay to surgery may lead to poorer clinical outcomes. The Red Blanket Protocol (RBP) is a communication algorithm intended to facilitate surgery as expediently and safely as possible. By developing a protocol for these channels of communication, RBP may reduce the time to surgical intervention and improve patient outcomes. Our aim was to identify whether patient outcomes, including time to surgery, blood product use and survival were improved by the Red Blanket protocol. Methods: Haemodynamically unstable adults in Middlemore Hospital, Aotearoa New Zealand from 1/1/2014 to 31/12/2015 were compared with RBP patients from 1/4/2017 to 1/4/2020. Time from emergency department (ED) to knife-to-skin (KTS) was compared between the groups. The number of blood products used, LOS and 30-and 90-day survival were also compared between the pre-protocol and RBP groups. Results: Thirty-two patients were identified in the pre-protocol group, and 25 in the RBP group. The median time from ED to KTS reduced from 84 to 70.5 min after the implementation of RBP (P = 0.044). The median number of blood products was 21 pre-protocol and 11.5 in the RBP group (P = 0.102). The median LOS was 8 versus 4 days in the RBP group (P = 0.204). 30-day survival rate was comparable in the two groups (65% versus 60% (P 0.71)). Conclusion: RBP was associated with a shorter time to knife-to-skin for haemodynamically unstable patients. There was no significant difference in clinical outcomes between the two groups. Larger studies are required to assess clinical outcomes of the RBP.

Catchy code names in trauma care cannot replace surgical decision‐making

“…Whilst Mohamed et al . looked at a slightly different population and the code was called Red Blanket not Code Crimson, the findings reinforced that process improvement is consistent across the ANZ articles on these protocols but we are no clearer on clinical outcomes 5 …”

“…Red Blanket, pre‐hospital Code Crimson, in‐hospital Code Crimson and OPSTAT are all protocols that are used for the management of the exsanguinating patient 1–6 . In Australasia they have been heavily communicated but varyingly adopted by providers of trauma care.…”

“…In Australasia they have been heavily communicated but varyingly adopted by providers of trauma care. Single‐institutional ‘pre and post’ papers have demonstrated a consistent reduction in time from the emergency department to the operating room since implementation of the protocols, but their impact on patient outcomes is harder to extrapolate 1,3–5 . It is difficult to establish evidence‐based practice in this patient population and it is unlikely that small local studies with reporting and publishing bias and all the possible flaws of pre‐ and post‐comparison studies would be able to provide high level of practice changing evidence.…”

“…Red Blanket, pre-hospital Code Crimson, in-hospital Code Crimson and OPSTAT are all protocols that are used for the management of the exsanguinating patient. [1][2][3][4][5][6] In Australasia they have been heavily communicated but varyingly adopted by providers of trauma care. Single-institutional 'pre and post' papers have demonstrated a consistent reduction in time from the emergency department to the operating room since implementation of the protocols, but their impact on patient outcomes is harder to extrapolate.…”

“…Single-institutional 'pre and post' papers have demonstrated a consistent reduction in time from the emergency department to the operating room since implementation of the protocols, but their impact on patient outcomes is harder to extrapolate. 1,[3][4][5] It is difficult to establish evidence-based practice in this patient population and it is unlikely that small local studies with reporting and publishing bias and all the possible flaws of pre-and postcomparison studies would be able to provide high level of practice changing evidence. Even in large meticulously designed randomized control trials they frequently failed to show the benefit of the investigated treatment such as medications or the ratio of blood products in the trauma population, making an institution-specific, subjectively defined, treatment delivery difficult to generalize.…”