Evaluating the time to surgery for low severity trauma patients within a trauma quality improvement program

There is potential for inequity in quality improvement and prevention initiatives of low severity trauma burden may not be considered proportionately in the context of their impacts on healthcare providers or the community. This study defines and tests a small preliminary set of common, low-severity injuries requiring non-urgent, operative interventions in a health region of NZ.

The regional trauma registry was reviewed to develop a short list of potential diagnostic groups to be used in testing the time from admission to surgery and selection criteria were applied to find appropriate injuries. The volume of presentations over a 10-year period were analysed.

A total of 3213 events with a single injury included in the five selected diagnostic groups met the study selection criteria. The most common (32.4%) diagnostic group was the simple forearm fracture. The supracondylar fracture was the most common (65.9%) group for the 0-14 year olds. The median time delay from arrival to first operative intervention was longest in the tibial fracture group at 45.4 h, and was shortest in the supracondylar fracture group at 10.0 h. Volumes varied between diagnostic groups from an average of 22 per-year for mandibular fractures to an average of 104 per-year for forearm fractures.

The results show that the variations in process applied to different diagnostic groups are measurable and can be observed over time. This provides a platform for further work on the quality indicators and benchmarking for delivery of care to patients with low severity trauma.