342 Enhanced Trauma Team Activations Reduces Elderly Major Trauma Patients’ Length of Stay by 17.7% (3 Days): A Multi-Centre 8-Year Pre and Post Intervention Study in Trauma Units

Abstract Aim Despite high injury severity scores (ISS), elderly major trauma patients are often not recognised expediently. Previous audit of North West London Major Trauma Network’s (NWL-MTN) TARN data (2015-2017) evidenced lower rates of trauma team activation (TTA) in Trauma Units (TUs) when comparing ISS 15 cohorts. This correlated with outcomes, as TTA patients were assessed earlier, with timelier CT-scans and reduced lengths of stay (LOS). Re-audit evaluated TTA performance after interventions enhancing practice including modified TTA tools, educational initiatives, 40% TTA targets and annual peer reviews, sustained from 2018 onwards. Method Retrospective analysis of six TUs from 2018-2022 was conducted. Adult patients ISS 15-45 were included. Annual TTA rates were compared between ‘elderly’ (65+) and ‘non-elderly’ (18-64) cohorts. Mann-Whitney-U tests explored differences in arrival to CT-times and LOS. (Significance at p0.05). Results Re-audit identified 2197 elderly patients (mean-ISS 21); 987 non-elderly patients (mean-ISS 22). Trauma Team Activation rates Elderly:2015-2017: 12% (pre-intervention)2018: 18%2019: 23%2020: 34%2021: 34%2022: 30% Non-elderly:2015-2017: 31% (pre-intervention)2018: 35%2019: 36%2020: 46%2021: 37%2022: 40% Elderly outcomes Assessment ≤5mins from arrival by ST3+:2015-2017: TTA: 60.6%; No-TTA: 11.0%2020-2022: TTA: 50.9%; No-TTA: 22.3% Mean CT-times (p0.001):2015-2017: TTA: 09.5hr; No-TTA: 20.1hr2020-2022: TTA: 04.3hr; No-TTA: 08.5hr Mean LOS days (p0.001):2015-2017: TTA: 13.2; No-TTA: 16.8. Total: 16.42020-2022: TTA: 12.3; No-TTA: 14.1. Total: 13.5 Conclusions Interventions have been effective with elderly TTA rates almost trebling since 2017. Earlier assessment, investigations and clinical management correlate directly with a 17.7% (3 Day) reduction in LOS.