Access to specialist care: Optimizing the geographic configuration of trauma systems.

BACKGROUND: The optimal geographic configuration of health care systems is key to maximizing accessibility while promoting the efficient use of resources. This article reports the use of a novel approach to inform the optimal configuration of a national trauma system. METHODS: This is a prospective cohort study of all trauma patients, 15 years and older, attended to by the Scottish Ambulance Service, between July 1, 2013, and June 30, 2014. Patients underwent notional triage to one of three levels of care (major trauma center [MTC], trauma unit, or local emergency hospital). We used geographic information systems software to calculate access times, by road and air, from all incident locations to all candidate hospitals. We then modeled the performance of all mathematically possible network configurations and used multiobjective optimization to determine geospatially optimized configurations. RESULTS: A total of 80,391 casualties were included. A network with only high- or moderate-volume MTCs (admitting at least 650 or 400 severely injured patients per year, respectively) would be optimally configured with a single MTC. A network accepting lower-volume MTCs (at least 240 severely injured patients per year) would be optimally configured with two MTCs. Both configurations would necessitate an increase in the number of helicopter retrievals. CONCLUSION: This study has shown that a novel combination of notional triage, network analysis, and mathematical optimization can be used to inform the planning of a national clinical network. Scotland's trauma system could be optimized with one or two MTCs. LEVEL OF EVIDENCE: Care management study, level IV.

Feasibility and utility of population-level geospatial injury profiling: prospective, national cohort study.

BACKGROUND: Geospatial analysis is increasingly being used to evaluate the design and effectiveness of trauma systems, but there are no metrics to describe the geographic distribution of incidents. The aim of this study, therefore, was to evaluate the feasibility and utility of using spatial analysis to characterize, at scale, the geospatial profile of an injured population. METHODS: This is a prospective national cohort study of all trauma patients attended to by the Scottish Ambulance Service in a complete year (between July 1, 2013, and June 30, 2014). Incident location and severity were collected at source. Incident distribution was evaluated using geostatistical techniques. RESULTS: There were 80,391 recorded incidents involving traumatic injury. Incident density was highest in the central Southern part of the country and along the East coast, broadly following the population distribution and road network. The overall distribution was highly clustered, and centered on the central Southern and Eastern parts of the country. When analyzed by triage category, the distribution of incidents triaged to major trauma center care was slightly less clustered than that of incidents triaged to trauma unit or local emergency hospital care, but the spread was similar. When analyzed by type of injury, assaults and falls were more clustered than incidents relating to traffic and transportation. CONCLUSION: This study demonstrates the feasibility and power of describing the geographic distribution of a group of injured patients. The methodology described has potential application for injury surveillance and trauma system design and evaluation.

Optimizing trauma system design: the GEOS (Geospatial Evaluation of Systems of Trauma Care) approach.

BACKGROUND: Trauma systems have been shown to reduce death and disability from injury but must be appropriately configured. A systematic approach to trauma system design can help maximize geospatial effectiveness and reassure stakeholders that the best configuration has been chosen. METHODS: This article describes the GEOS [Geospatial Evaluation of Systems of Trauma Care] methodology, a mathematical modeling of a population-based data set, which aims to derive geospatially optimized trauma system configurations for a geographically defined setting. GEOS considers a region's spatial injury profile and the available resources and uses a combination of travel time analysis and multiobjective optimization. The methodology is described in general and with regard to its application to our case study of Scotland. RESULTS: The primary outcome will be trauma system configuration. CONCLUSION: GEOS will contribute to the design of a trauma system for Scotland. The methodology is flexible and inherently transferable to other settings and could also be used to provide assurance that the configuration of existing trauma systems is fit for purpose.