Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Factors Affecting the Delay of a Decision to Admit Severe Trauma Patients and the Effect of a Multidisciplinary Department System: a Preliminary Study

중증 외상 환자의 입원 결정 지연에 영향을 미치는 요인과 공동진료시스템

  • Kang, Mun-Ju (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shin, Tae-Gun (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sim,, Min-Seob (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jo, Ik-Joon (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Song, Hyoung-Gon (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 강문주 (성균관대학교 의과대학 삼성서울병원 응급의학과) ;
  • 신태건 (성균관대학교 의과대학 삼성서울병원 응급의학과) ;
  • 심민섭 (성균관대학교 의과대학 삼성서울병원 응급의학과) ;
  • 조익준 (성균관대학교 의과대학 삼성서울병원 응급의학과) ;
  • 송형곤 (성균관대학교 의과대학 삼성서울병원 응급의학과)
  • Received : 2010.08.16
  • Accepted : 2010.10.25
  • Published : 2010.12.30
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Abstract

Purpose: Prolonged stay in the emergency department (ED), which is closely related with the time interval from the ED visit to a decision to admit, might be associated with poor outcomes for trauma patients and with overcrowding of the ED. Therefore, we examined the factors affecting the delay in the decision to admit severe trauma patients. Also, a multidisciplinary department system was preliminarily evaluated to see if it could reduce the time from triage to the admission decision. Methods: A retrospective observational study was conducted at a tertiary care university hospital without a specialized trauma team or specialized trauma surgeons from January 2009 to March 2010. Severe trauma patients with an International Classification of Disease Based Injury Severity Score (ICISS) below 0.9 were included. A multivariable logistic regression analysis was used to find independent variables associated with a delay in the decision for admission which was defined as the time interval between ED arrival and admission decision exceeded 4 hours. We also simulated the time from triage to the decision for admission by a multidisciplinary department system. Results: A total of 89 patients were enrolled. The average time from triage to the admission decision was $5.2{\pm}7.1$ hours and the average length of the ED stay was $9.0{\pm}11.5$ hours. The rate of decision delay for admission was 31.5%. A multivariable regression analysis revealed that multiple trauma (odds ratio [OR]: 30.6, 95%; confidence interval [CI]: 3.18-294.71), emergency operation (OR: 0.55, 95%; CI: 0.01-0.96), and treatment in the Department of Neurosurgery (OR: 0.07, 95%; CI: 0.01-0.78) were significantly associated with the decision delay. In a simulation based on a multidisciplinary department system, the virtual time from triage to admission decision was $2.1{\pm}1.5$ hours. Conclusion: In the ED, patients with severe trauma, multiple trauma was a significant factor causing a delay in the admission decision. On the other hand, emergency operation and treatment in Department of Neurosurgery were negatively associated with the delay. The simulated time from triage to the decision for admission by a multidisciplinary department system was 3 hours shorter than the real one.

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