Trauma systems – managed clinical networks for the delivery of trauma care – have been shown to reduce mortality and improve functional outcomes, by consolidating patients who have sustained severe injuries in fewer, specialised major trauma centres, and distributing the larger volume of less severely injured across smaller, more geographically dispersed facilities. This inclusive approach is intended to provide an integrated network of hospitals, with stratified capabilities, to ensure that all populations receive responsive, accessible and appropriate care.
Scotland is in the process of implementing a trauma system. The aim of the GEOS study was to determine geospatially optimised configurations, in terms of the designation of hospitals as major trauma centres, trauma units, and local emergency hospitals. The study prospectively triaged 80,391 injured patients attended by the Scottish Ambulance Service, over a period of 12 months, to the three levels of care, and then mathematically modelled drive- and flight-times, using multi-objective optimisation methodology, to derive optimised network configurations.
A network with only high- or moderate-volume major trauma centres (admitting at least 650 or 400 severely injured patients per year, respectively) would be optimally configured with a single major trauma centre, in Glasgow. A network accepting lower-volume major trauma centres (at least 240 severely injured patients per year) would be optimally configured with two major trauma centres, in Glasgow and Edinburgh. Both configurations would necessitate an increase in the number of helicopter retrievals.
This study has shown that a novel combination of notional triage, network analysis, and mathematical optimisation can be used to inform the planning of a national clinical network.
- Jan Jansen; email@example.com
Jansen JO, Morrison JJ*, Wang H, He S, Lawrenson R, Hutchison JD, Campbell MK. Access to specialist care: Optimising the geographical configuration of trauma care networks. Journal of Trauma and Acute Care Surgery 2015; 79(5): 756-65
Wang H, Jin Y, Jansen JO. Data-driven surrogate-assisted multi-objective evolutionary optimization of a trauma system. IEEE Transactions on Evolutionary Computation (in press)
Jansen JO, Morrison JJ*, Wang H, He S, Lawrenson R, Campbell MK, Green DR. Feasibility and utility of population-level geospatial injury profiling: prospective, national cohort study. Journal of Trauma and Acute Care Surgery 2015; 78(50): 962-9
Jansen JO, Morrison JJ*, Wang H, He S, Lawrenson R, Egan G, Campbell MK. Optimizing Trauma System Design: The GEOS (Geospatial Evaluation of Systems of Trauma Care) Approach. Journal of Trauma and Acute Care Surgery 2014; 76(4): 1035-4
Jansen JO, Campbell MK, on behalf of the GEOS Study Investigators. The GEOS study: designing a geospatially optimised trauma system for Scotland. Surgeon 2014; 12(2): 61-3