A 'Direct to operating room' approach improves critically injured patient outcomes.

Purpose of review: This review explores the rationale and evidence supporting the 'direct to operating room (DTOR)' treatment paradigm to improve critically injured patient outcomes. We examine elements that impact DTOR system development including prehospital care, patient selection, as well as infrastructure and logistic considerations.

Recent findings: DTOR systems require the ability to identify patients prior to emergency department arrival who would benefit from DTOR care, and immediately transport a patient upon emergency department arrival to an operative setting and bypass emergency department resuscitation. This typically involves positioning an operating room within or immediately adjacent to the emergency department. Effective DTOR systems decrease time to hemorrhage control and improve survival likelihood - particularly for patients hypotensive from a penetrating injury.

Summary: In a health system with the ability to reliably identify patients during prehospital transport or immediately upon emergency department arrival who are highly likely to require operative intervention, a DTOR approach improves operative outcomes and survival.