Injury, Int. J. Care Injured 34 (2003) 187–190 Reduction of time to definitive care in trauma patients: effectiveness of a new checklist system Patrick Schoettker * , Scott K D’Amours, Nadia Nocera, Erica Caldwell, Michael Sugrue Director of Trauma Department, Liverpool Hospital, Elisabeth Street, Liverpool, NSW 2170, Australia Accepted 10 August 2002 Abstract This study evaluated the feasibility of establishing a new trauma transfer checklist and assessed its impact on trauma-related interhospital transfers. A standard envelope with a printed checklist (N.E.W.S.) incorporating four key concepts in the care and transfer of trauma patients was used. A prospective comparison of consecutive interhospital trauma transfers to the major trauma service between July 1999–May 2000 (pre-N.E.W.S.) and August 2000–November 2000 (post-N.E.W.S.) was made. Changes in management satisfaction were assessed by a Likert scale (1 = poor to 5 = excellent). Pre-N.E.W.S., 88 trauma patients were transferred and 20 trauma transfers were recorded post-N.E.W.S. The time to definitive care pre-N.E.W.S. was 443 ± 322 min, and 339 ± 108 min (P = 0.014) post-N.E.W.S. The time in the referring hospital was also reduced from 343 ± 310 min pre-N.E.W.S. to 197 ± 90 min post-N.E.W.S (P = 0.0002). The checklist system prompted changes in the management of the trauma patient in 20% of the cases and there was a high level of satisfaction expressed by users of the checklist (4.6 ± 0.7). The N.E.W.S. checklist is effective in facilitating the interhospital transfer of trauma patients by shortening the time to definitive care. © 2002 Elsevier Science Ltd. All rights reserved. 1. Introduction Interhospital trauma transfer is a fundamental part of all trauma systems [6,12]. Despite the wider adoption of Ad- vanced Trauma Life Support (ATLS) [5], prolonged time to definitive care has been identified as an issue preventing optimal care of injured patients [1,8,16]. Early transfer of severely injured patients to a major trauma centre has been shown to be associated with better survival [1,18]. Errors in interhospital trauma transfers, such as inade- quate airway maintenance or inadequate cervical spine im- mobilisation, are well recognised in Australia and overseas [1,8,13]. Checklists are commonly used in the field of medicine, and safety benefits associated with their use have been demonstrated [10,15]. Previous research in South Western Sydney Area Health Service (SWSAHS) has identified that delays in interhospital trauma transfers and prolonged times to definitive care are not uncommon [3]. * Corresponding author. Tel.: +61-2-9828-3927; fax: +61-2-9828-3926. E-mail address: michael.sugrue@swsahs.nsw.gov.au (P. Schoettker). The aim of this study was to evaluate the feasibility of establishing a new trauma transfer checklist and to assess its impact on both the time taken for interhospital trauma patient transfers, and on patient management and interventions by the referring hospital. 2. Materials and methods South Western Sydney is a region of 6512 km 2 with a pop- ulation in excess of 750,000. It has four urban and one rural hospitals [14]. Liverpool Hospital is the designated Major Trauma Service (MTS) for the region; it has 520 beds, in- cluding 22 Intensive Care Unit beds. Since 1995, the Hospi- tal has had a dedicated direct access phone number (Trauma Hotline 02-9828-3666) for regional hospitals to access and arrange transfer of a multiply injured trauma patient. Since 1994, all patients admitted to Liverpool Hospital have been prospectively entered into a computerised trauma registry by three trauma nurses skilled in trauma data collection and trauma scoring [3]. A checklist incorporating four key concepts in the care and transfer of trauma patients was designed (Fig. 1). The checklist was chosen to enhance the existing concept and 0020-1383/02/$ – see front matter © 2002 Elsevier Science Ltd. All rights reserved. PII:S0020-1383(02)00280-2