An AUDIT of Nelson Trauma Call Activation - Are We Calling Enough?
Presenter: Dr Amber Moorcroft, Nelson Hospital
Authors List
Moorcroft, A., Nelson Hospital New Zealand Hood, G., Nelson Hospital New Zealand Hitchcock, C., Nelson Hospital New Zealand Stewart, M., Nelson Hospital New Zealand Browne, A., Nelson Hospital New Zealand
Introduction
Over the past five years, Nelson Hospital has undergone workforce restructuring, with more registered medical officers (RMOs) appointed to newly created registrar roles. This has shifted practice from a predominantly senior medical officer (SMO)-led model towards a more collaborative, teaching-based approach. Despite consistent rates of major trauma, recent review identified a lower-than-expected rate of trauma call activation (TCA).
Aims
To determine whether TCA remains lower than expected for major trauma at Nelson Hospital and identify opportunities to improve activation and patient outcomes.
Methods
Patients presenting to Nelson Hospital between June 2025 and June 2026 with major trauma (injury severity score [ISS] ≥13) were identified from the major trauma database. Records were retrospectively reviewed to determine whether TCA occurred in the emergency department. Mechanism of injury, injuries sustained and patient disposition were recorded to inform development of a revised TCA guideline.
Results
Sixty-eight patients with ISS ≥13 were identified; 25 (37%) received a TCA. Of 20 patients admitted to intensive care, 9 (45%) received TCA, compared with 16/48 (33%) among those with other dispositions. There was no significant difference in TCA between weekdays (17/45, 38%) and weekends (8/23, 35%), or daytime (18/47, 38%) and nighttime (8/21, 38%) presentations (both p=1.00). ISS was higher among ICU patients (mean 22, median 22) than those with other dispositions (mean 17, median 14). The most common mechanisms were motor vehicle crashes (16/68), falls from height (15/68) and mountain bike crashes (12/68).
Conclusions
The accepted benchmark for under-triage across trauma networks is approximately 5%¹. In this audit, 63% of patients meeting major trauma criteria did not receive TCA, indicating substantial under-triage. Contributing factors may include our single-tiered activation system, which is associated with increased under-triage² and discretionary activation criteria beyond haemodynamic instability. We propose a two-tiered activation system incorporating objective criteria and regionally common mechanisms of injury to improve TCA and support timely, appropriate trauma care.
References
Moorcroft, A., Nelson Hospital New Zealand Hood, G., Nelson Hospital New Zealand Hitchcock, C., Nelson Hospital New Zealand Stewart, M., Nelson Hospital New Zealand Browne, A., Nelson Hospital New Zealand
Introduction
Over the past five years, Nelson Hospital has undergone workforce restructuring, with more registered medical officers (RMOs) appointed to newly created registrar roles. This has shifted practice from a predominantly senior medical officer (SMO)-led model towards a more collaborative, teaching-based approach. Despite consistent rates of major trauma, recent review identified a lower-than-expected rate of trauma call activation (TCA).
Aims
To determine whether TCA remains lower than expected for major trauma at Nelson Hospital and identify opportunities to improve activation and patient outcomes.
Methods
Patients presenting to Nelson Hospital between June 2025 and June 2026 with major trauma (injury severity score [ISS] ≥13) were identified from the major trauma database. Records were retrospectively reviewed to determine whether TCA occurred in the emergency department. Mechanism of injury, injuries sustained and patient disposition were recorded to inform development of a revised TCA guideline.
Results
Sixty-eight patients with ISS ≥13 were identified; 25 (37%) received a TCA. Of 20 patients admitted to intensive care, 9 (45%) received TCA, compared with 16/48 (33%) among those with other dispositions. There was no significant difference in TCA between weekdays (17/45, 38%) and weekends (8/23, 35%), or daytime (18/47, 38%) and nighttime (8/21, 38%) presentations (both p=1.00). ISS was higher among ICU patients (mean 22, median 22) than those with other dispositions (mean 17, median 14). The most common mechanisms were motor vehicle crashes (16/68), falls from height (15/68) and mountain bike crashes (12/68).
Conclusions
The accepted benchmark for under-triage across trauma networks is approximately 5%¹. In this audit, 63% of patients meeting major trauma criteria did not receive TCA, indicating substantial under-triage. Contributing factors may include our single-tiered activation system, which is associated with increased under-triage² and discretionary activation criteria beyond haemodynamic instability. We propose a two-tiered activation system incorporating objective criteria and regionally common mechanisms of injury to improve TCA and support timely, appropriate trauma care.
References
- Curtis,K.,Olivier, J.,Mitchell, R.,Cook, A.,Rankin,T., Rana,A.& Nau,T.(2011).
- Thorsen,K.,Narvestad,J.K.,Tjosevik,K.E.,Larsen,J.W.,&Søreide,K.(2022).
