Harrigan Megan E, Boremski Pamela A, Collier Bryan R, Tegge Allison N, Gillen Jacob R
Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA.
J Trauma Inj. 2023 Sep;36(3):231-241. doi: 10.20408/jti.2023.0020. Epub 2023 Sep 13.
Overtriage and undertriage rates are critical metrics in trauma, influenced by both trauma team activation (TTA) criteria and compliance with these criteria. Analysis of undertriaged patients at a level I trauma center revealed suboptimal compliance with existing criteria. This study assessed triage patterns after implementing compliance-focused process interventions.
A physician-driven, free-text alert system was modified to a nonphysician, hospital dispatcher-guided system. The latter employed dropdown menus to maximize compliance with criteria. The preintervention period included patients who presented between May 12, 2020, and December 31, 2020. The postintervention period incorporated patients who presented from May 12, 2021, through December 31, 2021. We evaluated appropriate triage, overtriage, and undertriage using the Standardized Trauma Assessment Tool. Statistical analyses were conducted with an α level of 0.05.
The new system was associated with improved compliance with existing TTA criteria (from 70.3% to 79.3%, P=0.023) and decreased undertriage (from 6.0% to 3.2%, P=0.002) at the expense of increasing overtriage (from 46.6% to 57.4%, P<0.001), ultimately decreasing the appropriate triage rate (from 78.4% to 74.6%, P=0.007).
This study assessed a workflow change designed to improve compliance with TTA criteria. Improved compliance decreased undertriage to below the target threshold of 5%, albeit at the expense of increased overtriage. The decrease in appropriate triage despite compliance improvements suggests that the current criteria at this institution are not adequately tailored to optimally balance the minimization of undertriage and overtriage. This finding underscores the importance of improved compliance in evaluating the efficacy of TTA criteria.
过度分诊率和分诊不足率是创伤领域的关键指标，受创伤团队启动（TTA）标准以及对这些标准的遵守情况影响。对一家一级创伤中心分诊不足患者的分析显示，对现有标准的遵守情况欠佳。本研究评估了实施以遵守为重点的流程干预措施后的分诊模式。
将由医生驱动的自由文本警报系统修改为由医院调度员指导的非医生系统。后者采用下拉菜单以最大程度地遵守标准。干预前期纳入了2020年5月12日至2020年12月31日期间就诊的患者。干预后期纳入了2021年5月12日至2021年12月31日期间就诊的患者。我们使用标准化创伤评估工具评估了适当分诊、过度分诊和分诊不足情况。统计分析的α水平为0.05。
新系统与对现有TTA标准的遵守情况改善相关（从70.3%提高到79.3%，P = 0.023），分诊不足情况减少（从6.0%降至3.2%，P = 0.002），但代价是过度分诊增加（从46.6%增至57.4%，P < 0.001）——最终导致适当分诊率下降（从78.4%降至74.6%，P = 0.007）。
本研究评估了一项旨在改善对TTA标准遵守情况的工作流程变更。遵守情况的改善将分诊不足率降至了5%的目标阈值以下，尽管代价是过度分诊增加。尽管遵守情况有所改善，但适当分诊率却下降了，这表明该机构目前的标准并未充分调整以最佳平衡分诊不足和过度分诊的最小化。这一发现强调了在评估TTA标准的有效性时改善遵守情况的重要性。
