Locating trauma centers considering patient safety.

Area of Science:

• Public Health
• Operations Research
• Emergency Medicine

Background:

• Trauma is a leading cause of death and disability in the U.S. for individuals under 44.
• Geographical maldistribution of trauma centers (TCs) increases access time, potentially impacting patient safety and outcomes.
• Addressing trauma center accessibility is crucial for public health.

Purpose of the Study:

• Introduce the Trauma Center Location Problem (TCLP) to optimize TC number and location.
• Improve patient safety by minimizing mistriages (under-triage and over-triage).
• Develop an efficient method to find near-optimal solutions for realistic TCLP instances.

Main Methods:

• Model patient safety using mistriages: system-related under-triage (srUT) and over-triage (srOT).
• Employ a bi-objective optimization model to account for both srUT and srOT.
• Utilize a Particle Swarm Optimization (PSO) heuristic for efficient solution derivation.
• Estimate srUT and srOT using a notional tasking algorithm.

Main Results:

• Optimizing Ohio's 2012 trauma network with one additional TC reduced the objective function by over 31.5%.
• Redistributing existing TCs led to a 30.4% reduction in the objective.
• Solution sensitivity observed regarding weights for srUT/srOT, volume requirements, and EMS decision thresholds.

Conclusions:

• The proposed TCLP model and PSO heuristic offer an effective approach to trauma system optimization.
• Strategic trauma center network design can significantly enhance patient safety and reduce mortality.
• Findings highlight the importance of considering geographical distribution and triage accuracy in trauma care planning.