Workflow and Clinical Outcomes After Implementation of a Structured Trauma Protocol in a Resource-Constrained Emergency Department: A Single-Center Retrospective Before-and-After Cohort Study

Background/Objectives: Coordinated imaging and clinical decision-making are central to trauma care, but delays may occur in emergency departments without hybrid resuscitation–imaging facilities. We examined associations between a structured departmental quality-improvement workflow and trauma-process times in a resource-constrained emergency department. Methods: We retrospectively compared 360 consecutive eligible trauma patients (180 before and 180 after implementation). The post-protocol workflow combined early extended focused assessment with sonography for trauma (eFAST), prioritized computed tomography (CT) coordination, and brief post-resuscitation debriefing. The primary outcome was CT access time. Other workflow outcomes were evaluated as secondary endpoints; procedural and mortality findings were exploratory. Results: Median CT access time was 22.38 min (IQR 16.02–28.75) before implementation and 10.98 min (IQR 7.53–14.71) afterward (p < 0.001); the mean difference was −11.10 min (95% CI −12.69 to −9.50). Median consultation-request time was 23.23 versus 13.69 min, and median admission-decision time was 125.95 versus 49.08 min (both p < 0.001). Pre-CT tube thoracostomy was recorded more often in the post-protocol phase (3.3% vs. 11.7%; RR 3.50, 95% CI 1.45–8.47; p = 0.003). Differences in mortality were exploratory and cannot be attributed to the protocol. Conclusions: The post-protocol phase was associated with shorter trauma workflow intervals, particularly CT access time. Because this retrospective, uncontrolled comparison followed calendar sequence, it cannot establish a causal protocol effect. Procedural and mortality findings are hypothesis-generating; controlled studies are needed to assess reproducibility and patient-centered benefit.