Optimizing access and configuration of trauma centre care in New South Wales |
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| Institution: | 1. LifeFlight Retrieval Medicine, Brisbane, Australia;2. Anaesthesia Trauma and Critical Care, Lancashire, United Kingdom;3. Gold Coast University Hospital, Gold Coast, Australia;4. James Cook University, Queensland, Australia;5. SAAS MedSTAR, Adelaide, South Australia;6. Ambulance Victoria, Victoria, Australia;7. St Vincent''s Hospital, Melbourne, Australia;1. The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Australia;2. Royal Australasian College of Surgeons, Trauma Quality Improvement Sub-Committee, Australia;3. Australasian Trauma Society, Australia;4. Australian Trauma Quality Improvement Program (AusTQIP), Australia;5. Illawarra Shoalhaven Local Health District, NSW, Australia;6. University of Wollongong, Faculty of Science, Medicine and Health, Australia;7. Monash University, School of Public Health and Preventive Medicine, Australia;8. Queensland University of Technology, Australian Centre for Health Services Innovation, Faculty of Health, School of Public Health and Social Work, Australia;9. Jamieson Trauma Institute, Royal Brisbane and Women''s Hospital, Metro North Hospital and Health Service, Queensland Health, Australia;10. Trauma Service, Alfred Hospital, Victoria, Australia;11. Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia;12. Centre for Infectious Diseases and Microbiology and the Directorate of Nursing, Midwifery and Clinical Governance, Western Sydney Local Health District, Westmead, NSW, Australia;13. Waikato District Health Board, Hamilton, New Zealand;14. Waikato Clinical School, University of Auckland, New Zealand;1. Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, The University of Sydney, NSW 2006, Australia;2. Emergency Services, Illawarra Shoalhaven LHD, Wollongong, NSW, Australia;3. Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia;4. The George Institute for Global Health, King St, Newtown, NSW, Australia;5. Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, North Ryde NSW 2113, Australia;6. Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia;7. Greater Sydney Area HEMS, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport NSW 2200, Australia;8. NSW Institute of Trauma and Injury Management, Agency for Clinical Innovation, 1 Reserve Rd, St Leonards NSW 2065, Australia;9. The Children''s Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia |
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| Abstract: | IntroductionGetting the right patient, to the right place, at the right time is dependent on a multitude of modifiable and non-modifiable factors. One potentially modifiable factor is the number and location of trauma centres (TC). Overabundance of TC dilutes volumes and could be associated with worse outcomes. We describe a methodology that evaluates trauma system reconfiguration without reductions in potential access to care. We used the mature trauma system of New South Wales (NSW) as a model given the perceived overabundance of urban major trauma centres (MTC).MethodsWe first evaluated potential access to TC care via ground and air transport through the use of geographic information systems (GIS) network analysis. Potential access was defined as the proportion of the population living within 60-min transport time from a potential scene of injury to a TC by ground or rotary-wing aircraft. Sensitivity analyses were carried out in order to account for potential pre-hospital interventions and/or transport delays; travel times of 15-, 30-, 45-, 60-, and 90-min were also analyzed. We then evaluated if the current configuration of the system (number of urban MTS in the Sydney basin) could be optimized without reductions in potential access to care using two GIS methodologies: location-allocation and individual removal of MTC.Results86% of the NSW population has potential access to a TC within 60 min ground travel time; potential access improves to 99% with rotary-wing transport. The 1% of the population without potential TC access lives in 48% of the land area (>384,000km2). Utilizing two different methodologies we identified that there was no change in potential access by ground transport after removing 1 or 2 MTC in the Sydney basin at the 30-, 45-, and 60-min transport times. However, 0.02% and 0.5% of the population would not have potential access to MTC care at 15 min after removing one and two MTC respectively.DiscussionRedistribution of the number of MTC in the Sydney basin could be achieved without a significant impact on potential access to care. Our approach can be utilized as an initial tool to evaluate a trauma system where overabundance of coverage is present. |
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| Keywords: | Trauma systems Trauma centres Geographic information systems Access to care |
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