Trauma team activation varies across Dutch emergency departments: a national survey

Abstract

BackgroundTiered trauma team response may contribute to efficient in-hospital trauma triage by reducing the amount of resources required and by improving health outcomes. This study evaluates current practice of trauma team activation (TTA) in Dutch emergency departments (EDs).MethodsA survey was conducted among managers of all 102 EDs in the Netherlands, using a semi-structured online questionnaire.ResultsSeventy-two questionnaires were analysed. Most EDs use a one-team system (68 %). EDs with a tiered-response receive more multi trauma patients (p < 0.01) and have more trauma team alerts per year (p < 0.05) than one-team EDs. The number of trauma team members varies from three to 16 professionals. The ED nurse usually receives the pre-notification (97 %), whereas the decision to activate a team is made by an ED nurse (46 %), ED physician (30 %), by multiple professionals (20 %) or other (4 %). Information in the pre-notification mostly used for trauma team activation are Airway-Breathing-Circulation (87 %), Glasgow Coma Score (90 %), and Revised Trauma Score (85 %) or Paediatric Trauma Score (86 %). However, this information is only available for 75 % of the patients or less. Only 56 % of the respondents were satisfied with their current in-hospital trauma triage system.ConclusionsTrauma team activation varies across Dutch EDs and there is room for improvement in the trauma triage system used, size of the teams and the professionals involved. More direct communication and more uniform criteria could be used to efficiently and safely activate a specific trauma team. Therefore, the implementation of a revised national consensus guideline is recommended.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0185-0) contains supplementary material, which is available to authorized users.

Trauma team leaders in Canada: A national survey

“…There is also a great diversity of TTA criteria across the country. The great TT variability in Canada reported in this survey, and elsewhere, 9,21 confirms the weak evidence on the topic.…”

“…This disparity of activation criteria for TTs between trauma centres does not seem to be limited to Canada, as other countries face the same problem. 9,21,22 In Dutch emergency departments, 21 the most used information to activate TTs included Glasgow Coma Score (89.6%), airway-breathing-circulation (86.5%), paediatric trauma score (85.7%), revised trauma score (84.6%) and mechanisms of injury (80.4%). However, for criteria using demographic information (age, pregnancy), other physiologic parameters (respiratory rate, blood pressure, etc.)…”

“…24 It seems that an emergency physician, a surgeon, a respiratory therapist, two nurses and at least one patient attendant and one resident (seven TT members) reflect the ideal team across Canada. In Dutch EDs, TTs range from 3 to 16 professionals, with a median of seven; 21 more than half of their TTs consisted of at least two ED nurses, an emergency physician, a surgeon, a surgery/orthopaedics resident, an anaesthetist, a radiologist and a radiographer. An alternative study suggested that the ideal TT should be composed of an emergency physician, a surgeon, a neurologist, a radiology technician, an anaesthetist and two nurses.…”

The Potential of Collective Intelligence in Emergency Medicine: Pooling Medical Students’ Independent Decisions Improves Diagnostic Performance

“…Patients arriving at the emergency room (ER) with acute conditions are frequently seen by 2 or more physicians. Whereas noncritical patients are typically seen by at least 1 junior and 1 senior physician, team size can increase up to 15 clinicians or more [31][32][33][34] in high-acuity situations. 3 Physicians then make a joint diagnosis in an informal, nonstandardized way.…”

Simple modification of trauma mechanism alarm criteria published for the TraumaNetwork DGU® may significantly improve overtriage – a cross sectional study

“…In the context of a quality improvement project on the treatment of major trauma in a level II trauma centre one of the objectives was to adequately standardize emergency room (ER) treatment. No generally accepted international standard or national recommendations for ER trauma team activation (ERTTA) criteria (ERTTAC) were found in the literature, on the contrary, published trauma triage protocols are highly divergent [ 1 – 6 ]. We chose the most up-to-date ERTTAC published by and recommended for use in the German TraumaNetwork DGU ® (Table 1 ) [ 7 ].…”