Impact of the rural trauma team development course in Southwestern Ontario: change in practice and course evaluation.

Abstract

Purpose: The Rural Trauma Team Development Course (RTTDC) was introduced in 1998 in response to a growing number of deaths in rural areas due to trauma. Current literature provides evidence of the effectiveness of the RTTDC in reducing delays in the trauma transfer process in the United States. London Health Sciences Centre (LHSC) implemented the RTTDC in August of 2017. The objective of this study was to evaluate its impact in the Canadian setting.

Methods: A retrospective cohort study of referred trauma patients before and after delivery of the RTTDC was conducted. The primary outcome was the proportion of patients transferred within 3 h of arrival at referring hospital. Statistical analyses compared pre and post RTTDC groups. Following multiple imputation, multivariable logistic regression analysis was used to control for confounding between groups. A planned subgroup analysis included only patients who met trauma team activation criteria and/or had an ISS ≥16. Course attendee satisfaction was measured using the American College of Surgeons RTTDC 4th Edition Course Evaluation and the Southwest Regional Trauma Network RTTDC Evaluation.

Results: In total 180 patients were included in the study. Patients had a mean age of 52.0 (20.4) years, were most often male (73.3 %), sustained a blunt injury (92.8 %) with a mean ISS of 15.8 (10.5). The proportion of patients who were transferred within 3 h of arrival at primary hospital was 48.9 % pre-RTTDC and 56.7 % post-RTTDC (p = 0.370). Hosting an RTTDC did not have a significant impact on the proportion of patients transferred within 3 h of primary hospital arrival (OR = 1.18 (0.63, 2.20)). Median time (hours) spent at a primary hospital was similar (3.1 (1.4, 4.2) vs 2.7 (1.7, 3.8), p = 0.702), as was median decision to transfer time (hours) (1.5 (0.6, 2.5) vs 1.6 (0.6, 2.5), p = 0.837). Results of the subgroup analyses were similar (N = 98). Attendee satisfaction with the RTTDC was exceedingly positive.

Conclusion: In this study, participation in a one-day RTTDC did not result in a 20 % improvement in the proportion of patients being transferred from a referring hospital within 3 h. More accessible and sustainable educational outreach strategies are required to make further improvements.