Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after study
Purpose 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 assesse...
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Korean Society of Traumatology
2023-09-01
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| Series: | Journal of Trauma and Injury |
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| Online Access: | http://jtraumainj.org/upload/pdf/jti-2023-0020.pdf |
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| author | Megan E. Harrigan Pamela A. Boremski Bryan R. Collier Allison N. Tegge Jacob R. Gillen |
| author_facet | Megan E. Harrigan Pamela A. Boremski Bryan R. Collier Allison N. Tegge Jacob R. Gillen |
| author_sort | Megan E. Harrigan |
| collection | DOAJ |
| description | Purpose 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. Methods 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. Results 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). Conclusions 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. |
| format | Article |
| id | doaj-art-429ad0d33bc24743a78693ea48bcb752 |
| institution | Kabale University |
| issn | 2799-4317 2287-1683 |
| language | English |
| publishDate | 2023-09-01 |
| publisher | Korean Society of Traumatology |
| record_format | Article |
| series | Journal of Trauma and Injury |
| spelling | doaj-art-429ad0d33bc24743a78693ea48bcb7522025-01-16T05:40:00ZengKorean Society of TraumatologyJournal of Trauma and Injury2799-43172287-16832023-09-0136323124110.20408/jti.2023.00201267Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after studyMegan E. Harrigan0Pamela A. Boremski1Bryan R. Collier2Allison N. Tegge3Jacob R. Gillen4 Virginia Tech Carilion School of Medicine, Roanoke, VA, USA Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA Virginia Tech Carilion School of Medicine, Roanoke, VA, USA Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA Virginia Tech Carilion School of Medicine, Roanoke, VA, USAPurpose 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. Methods 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. Results 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). Conclusions 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.http://jtraumainj.org/upload/pdf/jti-2023-0020.pdftrauma centerstriagetrauma severity scoreswork flow |
| spellingShingle | Megan E. Harrigan Pamela A. Boremski Bryan R. Collier Allison N. Tegge Jacob R. Gillen Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after study Journal of Trauma and Injury trauma centers triage trauma severity scores work flow |
| title | Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after study |
| title_full | Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after study |
| title_fullStr | Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after study |
| title_full_unstemmed | Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after study |
| title_short | Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after study |
| title_sort | impact of nonphysician technology guided alert level selection on rates of appropriate trauma triage in the united states a before and after study |
| topic | trauma centers triage trauma severity scores work flow |
| url | http://jtraumainj.org/upload/pdf/jti-2023-0020.pdf |
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