Closing gaps in urban trauma systems: Outcomes of an inner-city community emergency department multidisciplinary...

Non-trauma center (NTC) emergency departments (EDs) play regular but underappreciated roles in the management of severely injured patients, yet many lack formal protocols to guide care. We describe the implementation and outcomes of a structured trauma evaluation and transfer protocol at an urban NTC emergency department.

A multidisciplinary trauma protocol was implemented on April 1, 2023, at an urban NTC, supported by a Level I trauma center, 2.5 miles apart. The study period ran from January 1, 2019, to June 30, 2025. Using pre-post study design, 62 patients treated prior to implementation were compared with 49 post-intervention patients. The primary outcome was time to transfer to the trauma center. Secondary outcomes included time to trauma alert activation, time to CT imaging, documentation completeness across six process metrics, clinical intervention rates, and mortality.

The two cohorts were well-matched in demographics and injury characteristics by regression analysis. Median time to transfer decreased significantly from 78 min (IQR 47-212) to 50 min (IQR 39-97) post-intervention (p = 0.011). Time to CT imaging decreased from a median of 90 to 34 min (p = 0.003). Documentation metrics improved (p ≤ 0.001). Mortality decreased from 9.7% to 6.1%, although this difference did not reach statistical significance.

Implementation of a structured trauma protocol reduced time to transfer and time to imaging in an urban community ED. These findings demonstrate that NTC hospitals can achieve meaningful improvements in trauma processes and support their integration as active contributors within inclusive regional trauma systems.