Improving CT scanner efficiency for trauma team activations in the emergency department





Abstract


Background and objectives


A Trauma Team Activation (TTA) is initiated when a patient has sustained a life or limb-threatening injury thereby necessitating resources of a large care team. Previously, a CT scanner was cleared at the time of the prehospital TTA call. Wide variability in the time it took to stabilize patients often led to extended CT scanner idle time. A new policy was developed whereby the team leader would prompt the ED clerk to provide a ‘5-min heads-up’ (5-min HU) notification to the CT scanner personnel as a patient was stabilized. At this point, the CT scanner was cleared. The purpose of this quality improvement project is to evaluate if the new policy saves CT scanner idle time.


Methods


Research interns prospectively followed incoming TTAs in the ED of a large, urban, Level I Trauma Center in November 2022. The interns collected the following time points: TTA notification page, 5-min HU notification, and arrival to CT. Data was analyzed using a non-parametric comparison test (Mann-Whitney U).


Results


A convenience sample of 46 TTAs was included. Trauma was blunt (85%; n = 39)) and penetrating (15%; n = 7). The median initial TTA announcement to CT arrival time was 24.0 min (IQR: 9.0 min). Previously, the scanner would have been held for this entire period. The median time from 5-min HU notification to CT arrival was 5.0 min (IQR: 4.0 min). The new policy saved a median of 19 min of CT scanner idle time per patient compared to the old policy ( p < 0.0001). The total CT scanner time saved was 818 min (13.6 h).


Conclusion


These data support the implementation of a 5-min HU policy in the ED for patients arriving as TTAs. This maximizes the availability of CT scanners for other patients in the ED while TTA patients are being stabilized.


1


Introduction


CT scanners serve a vital diagnostic role for many emergency department (ED) patients and optimizing their usage is important. Computed tomography (CT) scanning is nearly always used in the care of patients arriving at a trauma center as Trauma Team Activations (TTAs). A Trauma Team Activation (TTA) is initiated when a patient has sustained a life or limb-threatening injury and needs the resources of a large care team. The TTA workflow has been shown to decrease time to imaging and to improve patient outcomes [ ]. Typically, this is initiated by a pre-hospital notification from emergency medical services which prompts a trauma team assembly. The American College of Surgeons requires CT scanner availability within 15 min of patient arrival to a Level I Trauma Center [ ]. Assuring the availability of a CT scanner for a critically injured patient is important. However, holding a CT scanner open also limits its use for other ED patients. Previously at our Level I Trauma Center, a CT scanner was cleared at the time of the TTA call in anticipation of the likely need for patient imaging. Wide variability in the time it took to stabilize patients often led to extended CT scanner idle time. Because of this, a new policy was developed whereby the team leader would prompt the ED clerk to provide a ‘5-min heads-up’ (5-min HU) notification to the CT scanner personnel as a patient was stabilized. At this point, the CT scanner was cleared. The purpose of this observational quality improvement project was to evaluate if the new policy saved CT scanner idle time without adversely affecting patient care. As a quality improvement project, the institutional review board determined that the project did not meet requirements for review.


2


Methods


Research interns prospectively followed a convenience sample of incoming TTAs in the ED of a large, urban, Level I Trauma Center during the month of November 2022. This is a hospital with an annual ED census of 90,000. The annual TTA volume is 860 patients (60 pediatric patients) and there are two CT scanners available 24/7. The interns collected the following time points: TTA notification page, 5-min HU notification, and arrival to CT. The initial TTA notification time point was either initiated pre-hospital or by emergency medicine physicians at the time of determination that a patient met TTA criteria. Type of trauma, time of day and CT availability upon patient arrival were also noted. Data was analyzed using a non-parametric comparison test (Mann-Whitney U).


3


Results


A convenience sample of 46 TTAs was included during which a research assistant was present and able to identify the 5-min HU notification. Trauma was blunt among 39 patients (85%) and penetrating in 7 patients (15%). TTAs occurred during the day shift [7 am-3 pm: 16 patients (35%)], evening shift [3 pm–11 pm: 22 patients (47%)] and night shift [11 pm-7 am: 8 patients (18%)]. The median initial TTA announcement to CT arrival time was 24.0 min (IQR: 9.0 min). Previously, the scanner would have been held for this entire period. The median time from 5-min HU notification to CT arrival was 5.0 min (IQR: 4.0 min). The new policy saved a median of 19.0 min of CT scanner idle time per patient compared to the old policy ( p < 0.0001) – Fig. 1 . One extreme outlier was excluded from analysis. The total CT scanner time saved for the 45 patients was 818 min (13.6 h). There was one instance when the CT scanner was not immediately available at patient arrival. This led to a delay of two minutes in patient imaging. It was thought that the delay was more likely related to the arrival of two TTA patients in a short time window and not related to the new policy.


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Mar 29, 2024 | Posted by in EMERGENCY MEDICINE | Comments Off on Improving CT scanner efficiency for trauma team activations in the emergency department

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