Authors (including presenting author) :
Chu CMM(1), Tsui KL(1), Leung CY(1), Ha PK(1), Lau CL(1)
Affiliation :
(1) Department of Accident and Emergency, NTWC
Introduction :
Cases in non-trauma centre requiring secondary trauma diversion (STD) to trauma centre should be managed within 40 minutes according to pledge time. We conducted an audit on the emergency department length of stay (LOS) of these patients in two district hospitals.
Objectives :
To assess performance of STD
Methodology :
A retrospective review of trauma registry was conducted between January 2020 and December 2021. Target population were patients in POH and TSWH requiring STD. Outcome was emergency department LOS.
Result & Outcome :
There were 127 STD cases, 100 from POH and 27 from TSWH. Median LOS was 55 minutes (Range: 26 to 253 minutes). 24 cases met the pledge time of 40 minutes (18.9%), 22 from POH and 2 from TSWH. Median LOS of POH and TSWH were 51 and 60.5 minutes respectively without statistically significant difference (p=0.179, Mann-Whitney U test). Number of triage category 1, 2, 3 and 4 cases were 17, 81, 27 and 1 respectively. We cannot conclude there is an association between achieving pledge time and hospital (p=0.086, chi-square test), or an association between achieving pledge time and triage category (p=0.052, chi-square test). Median LOS in 2020 and 2021 were 50.5 and 58.5 minutes respectively without statistically significant difference (p=0.055, Mann-Whitney U test). The median waiting time to cubicle was only 5 minutes, which indicates a substantial duration of post-triage management was spent before dispatch to dedicated trauma centre. The arrival pledge time of priority one ambulance is within 15 minutes, hence the upper limit of requesting ambulance should be set at 25 minutes to meet the length of stay target. Only 17.5% requested ambulance within 25 minutes. Prompt transferal of patients to trauma centre is shown to improve morbidity and mortality. There remains much room to improve the pledge time achievement in these two district hospitals. Intervention should be performed to shorten LOS in non-trauma centre to enhance trauma outcomes.
