Improving the 'Golden Patient' Initiative at a British Major Trauma Centre: A Single-Centre Study

Introduction Delays in theatre start times are expensive and associated with poor outcomes. To reduce these delays, a Golden Patient (GP) protocol was used at one of Britain's major trauma centres, the Queen Elizabeth University Hospital, Glasgow. We sought to clarify how often Golden Patients (GPs) were stepped down from being first on the day's trauma list and to identify significant contributing factors.  Methods We collected data over an eight-week period, with 80 GPs collated in total. If stepped down, we recorded their age, gender, injury, location, and day of planned surgery. Univariate analyses were then performed to test for statistical significance. We also followed stepped-down patients, noting how long until they received their operation. Results The incidence of GPs stepped down from being first on the list was 11.25%. This did not vary with age, gender, or type of injury, but was significantly associated with patients being at home the night before their planned operation (p=0.0114) and cases occurring on Fridays (p=0.0139). Of those stepped-down GPs who remained for operative management, all received their operation within one day. Conclusion This study, the first of its kind since the COVID-19 pandemic, shows low rates of GP step down, comparable to previous audits of GP initiatives in similar centres. When delays did occur, GPs received timely operative management once underlying issues were resolved. This study suggests that planned GPs should be admitted the night before their operation. Whilst the GP system serves trauma patients well, we identified areas for improvement in the efficiency of our own service applicable to other busy major trauma centres.