Trauma protocol halves the time it takes to get hemorrhage patients in the IR suite
Experts at an Ohio health system have developed a trauma protocol that can significantly reduce the time it takes to get patients with uncontrolled bleeding into the interventional suite.
Hemorrhages contribute to a substantial portion of trauma-related deaths. Interventional radiologists play a crucial role in stopping or controlling bleeding in these patients, but their effectiveness is often hindered by time; the more time that passes before interventions are enacted, the greater the risk of adverse outcomes.
For this reason, most trauma centers have guidelines in place that address time constraints related to uncontrolled bleeding. However, these recommendations are not without fault. This is what led a team of experts at OhioHealth Riverside Methodist Hospital to develop their own interventional protocols specific to hemorrhages. They detailed their efforts recently in Cureus.
“In recent years, the management of hemorrhagic trauma patients has expanded to include interventional radiology (IR),” first author Aahad Khan, MD, and colleagues noted. “The American College of Surgeons Committee on Trauma recommends that Level 1 and 2 trauma centers ensure IR availability within 60 minutes of the decision to proceed with angiography. Delays in IR intervention are associated with poorer outcomes and increased mortality.”
Their protocol was the result of a collaborative effort of a multidisciplinary group of professionals, including interventional radiologists, vascular surgeons, emergency physicians and nurses. It involves direct communication among each member of the trauma team.
The expedited intervention begins when patients with hemorrhagic bleeding are identified via imaging. When this is the case, the trauma team leader (TTL) directly contacts the interventional radiologist to review imaging and determine the need for endovascular intervention. If the IR finds that intervention is needed, a nurse places a STAT order for IR consultation with the patient and begins tracking the time until vascular access is achieved. Once an IR alert has been placed, the TTL and charge nurse coordinate to prep the patient and reserve and prepare an interventional suite.
The organization implemented the protocol on March 1, 2023. When comparing data from before and after its integration into trauma workflows, the team observed significant improvements in the time that lapsed between the discovery of hemorrhagic bleeding and the moment vascular access was achieved. Prior to the intervention, consult-to-needle times were around 102 minutes; after, these times were effectively halved, with consult-to-needle taking approximately 48 minutes post-intervention.
“Transitioning a patient from the trauma bay to the IR suite requires seamless coordination across multiple teams, and delays can negatively impact outcomes. Establishing a standardized institutional protocol can reduce time to intervention by streamlining workflows and minimizing communication-related delays,” the authors wrote.
The group acknowledged that their findings were limited by a small sample size, but noted that the data they have continued to collect since launching the protocol further supports its implementation.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.