Development and Testing the Effectiveness of Emergency Department Critical Trauma Management Model Implementation

Abstract

           Proper initial management of critically ill trauma patients by multidisciplinary teams at emergency departments (ED) is crucial. This implementation study aimed to develop an ED Critical Trauma Management Model (EDCTM model) and to test its effectiveness on ED management duration and the mortality rate among critically ill trauma patients. The conceptual framework for EDCTM model development and implementation consisted of the clinical practice guidelines of the National Health and Medical Research Council (NHMRC), Australia. The three groups of samples in this study were as follows: 1) the model developer group included 4 participants (1 physician and 3 nurses); 2) the model user group consisted of 20 participants (6 physicians and 14 nurses); and 3) the critically ill trauma patient group consisted of 159 participants (110 persons before the model implementation and 49 persons during the model implementation). Information regarding the process and results of the ED critically ill trauma patient management was recorded in the OPServ program which was part of the hospital healthcare information system.
          The findings from the study revealed the following.
          1. The EDCTM Model included 3 ED management phases: 1) ED preparation phase, 2) ED management phase, and 3) ED discharge preparation phase. The ISBAR was applied thoroughly for information handover wherever appropriate;
           2. The EDCTM Model implementation decreased the mean of ED management duration from 74.51 (SD = 34.77) minutes to 59.76 (SD = 26.58) minutes; and decreased critical ill trauma patients’ mortality rate from 16.36% to 6.12%.
           The EDCTM model has shown its effectiveness in critically ill trauma management in this study. It should be continuously implemented, and yearly outcomes should be evaluated to prove its sustainability and effectiveness.