Evaluation of a dual-room sliding gantry CT concept for workflow optimisation in polytrauma and regular in- and outpatient management
Introduction
With the importance of CT diagnostic in trauma patients ever-increasing, efforts have recently been made so as to provide for around the clock CT accessibility for trauma patients and to shorten the time from patient arrival to CT scanning while still allowing for the utmost CT efficiency.
Trauma accounts for a significant amount of death in younger people [1], [2], [3], [4]. The consistently improving trauma care has made it possible to pull patients with ever-increasing severity of injuries through. Whole body CT scanning has become an essential part of trauma room diagnostics. Several studies have already suggested its potential benefits on polytrauma patient survival [5], [6], [7]. Providing for early CT scan in polytrauma patients has also been suggested to potentially be crucial for the patients’ outcome, especially for unstable, severely injured patients [8]. However, literature has not reached a consensus yet as beneficial influence of whole body CT on polytrauma patient survival has not been ultimately proven [9], [10], [11], [12], [13].
Nevertheless, providing for early trauma care CT scans often cause problems [14] due to additional transports as the CT is often not located in the trauma room itself but in the radiology department. This is both time consuming in polytrauma management and can do further harm to the patient due to additional transfers.
We introduced a trauma room workflow concept by installing a double room solution embedded with a sliding gantry CT into the trauma room. Recent studies have already shown a new trauma workflow concept using a sliding gantry CT in the trauma room [15], [16], mostly within one room solutions and thus lacking the possibility of increasing efficacy by using the sliding gantry not only for trauma but also for regularly scheduled, non-trauma in- and outpatients.
This study was conducted in order to reveal the impact on workflow from introducing a sliding gantry CT in a dual-room concept with the trauma room being directly adjacent to the CT suite. The focus of interest was if and how this concept can improve the diagnostic work-up of polytrauma patients and what the impact on care of regularly scheduled out- inpatients is with regard to throughput efficiency and degree of capacity utilisation.
Section snippets
Concept 1
The old concept included a trauma room neighbouring a regular CT suite for regularly scheduled in- and outpatients (Somatom Sensation 16, Siemens). The trauma patient had to be moved to the CT suite for examination, and to be transferred back to the trauma room for treatment after medical imaging, thus postponing imaging of regularly scheduled patients (Fig. 1).
Concept 2
A sliding gantry CT (Somatom Definition AS, Siemens) was introduced into the same CT suite neighbouring the same trauma room for the
Sliding gantry CT vs. immobile CT in polytrauma management: concept 1 vs. concept 2
For concept 1, our old trauma room solution, 186 patients in 161 days were admitted to the trauma room with 30 being during working hours during the week and eligible for being analysed and respectively 31 out of 106 in 126 days for concept 2.
Groups were comparable as to age (p-value 0.86) and gender (p-value 0.6), ISS (p-value 0.66) and GCS (p-value 0.37), see Table 2.
The median time from patient arrival in the trauma room until the beginning of CT scanning was 21 min for concept 1 and 15 min
Discussion
Early CT diagnostic in acute trauma patients has become a valuable part in state-of-the-art trauma care, and Huber-Wagner et al. [17] have already suggested benefits regarding patient survival. Although their study has led to a delicate discussion, the need to integrate trauma CT imaging within the radiological clinical routine is thus given. The trauma patient has to be served as quickly as possible while regularly scheduled in- and outpatients’ waiting times have still to be kept in mind and,
Financial disclosure
Ralf W. Bauer and J. Matthias Kerl are on the speakers’ bureau of Siemens Healthcare, Computed Tomography. Our department has received research support by Siemens Healthcare for other projects than the currently submitted work. No funding was received for the submitted work from any source.
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