Impact of a Novel Level III Trauma Activation Protocol Utilizing Trauma Nurse Clinicians

Tiered trauma activation protocols help physicians prioritize the severely injured but may delay care for those with less severe injuries. While trauma nurse clinicians (TNCs) have been shown to provide efficient trauma care, their impact as primary responders for Level III trauma activations has not been studied.

This study aims to evaluate the impact of TNC response to Level III trauma activations on patient outcomes.

This pre- and postintervention study was conducted at a Midwestern United States Level I trauma center from July 1, 2023, to October 10, 2023, and included adult and pediatric trauma patients. In July 2022, we implemented a protocol where TNCs replaced physicians responding to Level III trauma activations. Data from the trauma registry and electronic medical records were analyzed before and after implementation. The primary outcome was time to computed tomography within 30 minutes. Secondary outcomes were emergency department (ED) time, hospital length of stay (LOS), and 30-day readmissions.

The final analysis included 812 post-intervention patients (562 with TNCs, 250 without TNCs), of which 53% were male. Groups were comparable in age and Injury Severity Score at baseline. Patients seen by TNCs were more likely to receive computed tomography (CT) within 30 minutes (56% vs 35%, p < .0001), while ED and hospital LOS and readmission rates showed no significant difference between groups.

This study showed that trauma nurse clinicians' response to third-tiered activations is feasible and improves timely access to CT within 30 minutes, but it showed no effect on ED time, hospital LOS, or hospital readmissions.