There is evidence that shows delays from ED to OR increase the risk of mortality in hypotensive (very low blood pressure) patients with penetrating injuries.

According to a manuscript publication in The Journal of Trauma and Acute Care Surgery, delay to the operating room of more than 10 minutes increase the risk of mortality by almost threefold in hypotensive patients with a gunshot wound¹. Hospitals in the Arkansas Trauma System are able to activate "trauma teams", a specially trained group of nurses and doctors, to provide urgent trauma care to the patient. Protocols should be designed to shorten the time that patients with these injuries spend in the emergency department.

This metric tells us the percentage of hypotensive patients with penetrating injuries who spend more than two hours in the emergency department before going to the operating room.

Source: ¹Meizoso, J. P., Ray, J. J., Karcutskie IV, C. A., Allen, C. J., Zakrison, T. L., Pust, G. D., ... & Livingstone, A. S. (2016). Effect of time to operation on mortality for hypotensive patients with gunshot wounds to the torso: the golden 10 minutes. Journal of Trauma and Acute Care Surgery, 81(4), 685-691.

• Statewide Trauma Centers
• Emergency Medical Service (EMS) or Ambulance Agencies
• Arkansas Trauma Communications Center (ATCC)
• Trauma Advisory Council (TAC)
• Trauma Regional Advisory Council (TRAC)

Statewide education and ensuring that trauma centers have the resources to meet the indicator is essential. Some of the educational efforts that are underway include: Rural Trauma Team Development Course and Advanced Trauma Life Support. Designated Trauma Centers are funded to assist in the purchase of equipment and programs that will improve performance and ultimately patient outcomes.

The Arkansas Department of Health will continue to promote and provide trauma-specific education to providers and support reporting efforts using data from the Arkansas Trauma Registry and other relevant sources.

Regional and statewide quality improvement comittees meet regularly to review the charts of cases where opportunities for improvement may exist. These opportunities include reducing the amount of time critically injured patients are in the emergency room before going into the operating room. The findings from these reports are provided to the trauma section where they are used to guide future educational efforts.

Furthermore, a review of trauma deaths is conducted each quarter to assess opportunitiess for improvement in patient care. The identified opportunities are then used to identify specific areas of need regarding education that will improve patient outcomes.