Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after study

  • Megan E. Harrigan (Virginia Tech Carilion School of Medicine) ;
  • Pamela A. Boremski (Department of Surgery, Carilion Roanoke Memorial Hospital) ;
  • Bryan R. Collier (Virginia Tech Carilion School of Medicine) ;
  • Allison N. Tegge (Fralin Biomedical Research Institute at VTC) ;
  • Jacob R. Gillen (Virginia Tech Carilion School of Medicine)
  • Received : 2023.04.06
  • Accepted : 2023.06.22
  • Published : 2023.09.30
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Abstract

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.

Keywords

Acknowledgement

The authors thank Cara Spivey, MS (Virginia Tech Carilion School of Medicine; Carilion Clinic Research and Development, Roanoke, VA, USA), for her support on this project.

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