Audit of time to emergency trauma laparotomy

Background: An analysis of the process of care may improve quality of care within a trauma system. Early operative control of haemorrhage is vital and any delay before surgery may adversely affect outcome. Methods: Times from activation of the aeromedical team to arrival in the emergency department and the operating room for patients with liver or spleen injury were analysed to identify factors that delayed laparotomy. These results were compared with those of a national database. Results: The median time from emergency call to operation was 127 min (140 min for blunt and 86 min for penetrating injuries). Time from arrival in the emergency department to the operating room was 54 min (56 min for blunt and 37 min for penetrating injuries). An audit filter, set at the upper quartile of the emergency call to operating room time, selected 21 patients whose records were examined; five correctable delays were identified. Compared with the national trauma database, these patients had longer on-scene times, but significantly shorter times to operation from the emergency call (127 versus 161 min) and arrival at the emergency department (54 versus 115 min), although the patients were more severely injured (median Injury Severity Score 34 versus 24). Conclusion: The time to emergency trauma laparotomy may be used effectively as an audit of process for the clinical governance of a trauma system.