Impact of a comprehensive trauma pathway on workflow and clinical processes in a level III trauma center

Organized trauma systems improve coordination of care and may enhance the efficiency of trauma management, potentially improving outcomes and reducing hospital length of stay and costs. The aim of the study was to evaluate key process-of-care indicators and clinical outcomes before and after the introduction of a comprehensive trauma pathway.

We conducted a single-center retrospective-prospective cohort study at Rivoli Hospital, Italy. Trauma patients admitted to the Emergency Department (ED) between 2024 and 2025 who met the criteria for trauma team activation were prospectively included. Outcomes were compared with a retrospective cohort from the period prior to the implementation of the dedicated trauma pathway (2023-2024).

A total of 465 patients were included. Implementation of a comprehensive trauma pathway was associated with significant improvements in several time-dependent quality indicators, including ED boarding time (888 vs. 1021 min; p = 0.02), time to imaging (48 vs. 78 min; p < 0.01), time to surgery (183 vs. 237 min; p = 0.03), time to ICU admission (226 vs. 343 min; p = 0.02), and time to interhospital transfer (238 vs. 305 min; p = 0.04). We observed a trend toward a reduction in early mortality (2% vs. 3.6%; p = 0.41) and 30-day mortality (3.7% vs. 5.9%; p = 0.62).

The adoption of a structured multidisciplinary trauma management pathway was associated with improved timeliness of care for trauma patients. Although mortality rates were lower after pathway implementation, the study was not powered to demonstrate a survival benefit.