The journey towards implementing two tier trauma team activation and a trauma registry in a regional Australian Emergency Department: Research, audit, review, education, and change management

Mrs Elizabeth Quinn3

1Rockhampton Hospital, ROCKHAMPTON, Australia, 2Griffith University, GOLD COAST, AUSTRALIA, 3Australasian Trauma Society, , Australia

Background: Trauma team activation has changed from a one tier system (based on mechanism of injury, anatomical injuries and physiological changes) to a two tier system (using more specific criteria) to inform the number and type of personnel required in many hospitals  Distance to definitive care, increasing numbers of patients presenting due to trauma, demographic profiles and mechanisms of injury are important considerations in regional Australia. Rockhampton Hospital is a Level III Trauma Centre in Central Queensland and receives trauma patients from local and outlying areas, with initial management by one tier trauma team activation. The hospital has no electronic trauma registry and no means of calculating Injury Severity Score (ISS). In order to evaluate trauma team activation and care it is necessary to export data from Emergency Department Information System (EDIS) for all patients with a trauma related ICD 10 AM diagnosis and review paper based Trauma Record Forms to obtain more trauma specific information. Changes in trauma systems within the hospital occur slowly, as described in Roger’s Diffusion of Innovations Theory.

Aims: Kotter’s 8 Stages of Change Management have and will be used to implement changes in: (1) trauma team activation, and (2) recording, and storing of trauma related patient information.

Method: A team of key stakeholders with clinical governance was formed. An international literature review of two tier trauma team activation was undertaken to determine which criteria should be used for the two tiers of trauma team activation. Agreement was reached regarding the adoption of these criteria to inform the decision support tool (flowchart) for trauma team activation and a new two tier trauma team activation policy for the hospital. The search for electronic trauma registries and decision support systems suitable for trauma team activation and integration into the electronic medical record has begun.


Elizabeth Quinn was the first Credentialed Emergency Nurse in Australia, and an Ambassador and peer reviewer for CENA credentialing. She recently celebrated 30 years as a Registered Nurse, and completed her Graduate Certificate and Masters Emergency Nursing at Griffith University in 2014 and commenced her Honours Dissertation in 2015 with the topic Meeting trauma call criteria in a regional Australian Emergency Department. Elizabeth is passionate about improving care for trauma patients at Rockhampton Hospital. Elizabeth facilitated CENA Trauma Nurse Program in 2015 and  2016, and was a Clinical Nurse / Clinical Clinical Facilitator in Rockhampton Emergency Department. Elizabeth commenced her post graduate studies in Health Informatics, Health Finance and Project Management at Griffith University this year in order to facilitate her advocacy for Trauma registry implementation at Rockhampton Hospital. She is the Secretary of the Central Queensland Hospital and Health Services

Trauma Review Committee, a qualified AIS injury coder, and a member of Australasian Trauma  Society and Trauma Nurses Network. Elizabeth is currently employed as Nurse Manager Clinical Informatics.