Theoretical and actualized trauma care in a level 3 trauma centre

The concept of trauma systems is a generally agreed upon principle in the world of trauma, where patients access appropriate care for their injuries in an appropriate time frame, resulting in rehabilitation and reintegration into society. The literature favours care of the severely injured at tertiary centers, thus a system is formed to pull the patient to the ideal center of care. Though theoretical frameworks exist, how the system is actualized remains ambiguous, variable, and difficult to capture. Current system measurements perhaps are not reflecting system actualization, especially for non-tertiary centers with no staff assigned to surveillance of the injured patient through the system. After a scoping review of the literature, it was found that secondary triage and subsequent under-triage could be a significant indicator of system function and actualization. Thus, a retrospective chart review was done at a non-tertiary center to assess system function through secondary triage to tertiary care. All injured patients transferred to a tertiary center from a level 3 trauma center between January 1, 2017-December 31, 2017 were reviewed. Inpatient transfers were used to reflect under triage. It was found that patients had a 50% likelihood of being appropriately triaged when they met the major trauma patient criteria of the health authority. Call times to the patient transfer network were poorly documented and showed significant delay of access to care. As well, results showed a significant underuse of general surgery consultation with only 5 of the 27 patients being seen by the service, 4 of them were then transferred from the emergency department. Though this site has theoretical system planning, support tools, and algorithms—actualization was variable and showed an underappreciation for the injuries and their sequelae. Exploring tools to decentralize surveillance and influence include a using a simple Cribari Matrix to calculate an under-triage rate, applying a Learning Health Systems cycle, and drawing on High Reliability Organization principles to optimize care. Ultimately, culture will drive practice, therefore it is imperative that we drive culture with relentless intention to best influence the care of the injured.Medicine, Faculty ofSurgery, Department ofGraduat