Access to specialist care
| Autor: | James D Hutchison, Handing Wang, Marion K Campbell, Jan O. Jansen, Jonathan J. Morrison, Shan He, Robin Lawrenson |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Emergency Medical Services Critical Care and Intensive Care Medicine Health Services Accessibility Cohort Studies Injury Severity Score Trauma Centers Outcome Assessment Health Care Health care Emergency medical services Information system Humans Medicine multiobjective optimization Prospective Studies Aged Aged 80 and over geographic information systems Health Services Needs and Demand Trauma systems Geography business.industry Major trauma Original Articles Evidence-based medicine Middle Aged medicine.disease Triage Scotland Wounds and Injuries Female Surgery Medical emergency Emergency Service Hospital business Delivery of Health Care Information Systems Specialization Cohort study |
| Zdroj: | The Journal of Trauma and Acute Care Surgery |
| ISSN: | 2163-0755 |
| DOI: | 10.1097/ta.0000000000000827 |
| Popis: | BACKGROUND: The optimal geographic configuration of health care systems is key to maximizing accessibility while promoting the efficient use of resources. This article reports the use of a novel approach to inform the optimal configuration of a national trauma system. METHODS: This is a prospective cohort study of all trauma patients, 15 years and older, attended to by the Scottish Ambulance Service, between July 1, 2013, and June 30, 2014. Patients underwent notional triage to one of three levels of care (major trauma center [MTC], trauma unit, or local emergency hospital). We used geographic information systems software to calculate access times, by road and air, from all incident locations to all candidate hospitals. We then modeled the performance of all mathematically possible network configurations and used multiobjective optimization to determine geospatially optimized configurations. RESULTS: A total of 80,391 casualties were included. A network with only high- or moderate-volume MTCs (admitting at least 650 or 400 severely injured patients per year, respectively) would be optimally configured with a single MTC. A network accepting lower-volume MTCs (at least 240 severely injured patients per year) would be optimally configured with two MTCs. Both configurations would necessitate an increase in the number of helicopter retrievals. CONCLUSION: This study has shown that a novel combination of notional triage, network analysis, and mathematical optimization can be used to inform the planning of a national clinical network. Scotland's trauma system could be optimized with one or two MTCs. LEVEL OF EVIDENCE: Care management study, level IV. |
| Databáze: | OpenAIRE |
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