The effects of time of trauma patient presentation on emergency department utilization

All three posed temporal questions have now been answered as being positive factors in ED utilization: 1) Major and minor trauma patients should be expected to present at ED in largest numbers around 17.67 hr each day and especially during the month of August. Some types of major trauma (i.e., medical, surgical, psychiatric patients) require longer periods for stabilization in the ED before being discharged to the appropriate care unit. Such patients also tend to arrive later at the ED than do patients destined for MICU, SICU, or CCU. 2) Changing the trauma ordinance did not affect the temporal effects noted above but did produce a strikingly large influx of minor trauma presents relative to major trauma presents during the post-ordinance period. 3) The nature and number of the ED staffing should be reviewed and probably changed in order to reflect the large influx of trauma presents during the 1600 to 2400 hr shift. The third question has the most impact on ED utilization during the "Golden Hour of Trauma". Individual emergency departments must cope with the fact that the maximum demand on facilities and professional health expertise will normally occur during the hours from 1600 to 2400 each day. Some EDs have recognized this increased demand and have responded by maximizing the quantity and quality of their staff on the 1600 to 2400 hr shift. These data indicate that more EDs should follow suit as soon as possible.