Getting to the Right Place: Implementation of Triage and Transportation Guidelines in Fraser Health

Over 450,000 people are treated in emergency departments across BC each year. The most severely injured among them experience better outcomes if they’re treated at designated trauma centres which are best equipped to care for patients with serious, life-threatening injuries.

In order to improve health outcomes for patients with major trauma, BC Emergency Services (BCEHS), Trauma Services BC and the province’s health authorities worked together to develop Provincial Pre-Hospital Trauma Triage and Transport Guidelines. Released in February 2019, the goal of the guidelines was to standardize recognition and destination decision-making among paramedics, to ensure patients with major trauma are transported to the right place.

BCEHS established a working group with stakeholders from Trauma Services BC and Fraser Health (chosen as the pilot site), including patients and Indigenous Peoples, to implement the guidelines. Frontline paramedics were surveyed to inform the education and communication strategy, and changes to the electronic patient health record were created to help identify major trauma patients.

Prior to this project, it was difficult to assess whether paramedics were recognizing major trauma patients and choosing the right destination. BCEHS and Trauma Services BC worked together to link data from pre-hospital electronic health records to in-hospital data from the BC Trauma Registry. This linkage allowed BCEHS to understand the impact of pre-hospital care on a patient’s journey through the health care system, and permitted it to identify when major trauma patients within Fraser Health were being transported to a lead trauma hospital.

The guidelines, supported by education and continuous evaluation, had an immediate and positive impact. Between April 1, 2019, and March 31, 2020, 81 percent of patients who sustained major trauma were transported directly to a lead trauma hospital — an increase of 28 percent. Paramedic compliance was 88.5 per cent, and 92.6 percent of patients had their care records successfully linked.

With the Fraser Health pilot proving the value of this project, BCEHS is leveraging strong relationships with provincial stakeholders to spread this project across BC. And its value extends beyond emergency care: the linked data platform can be used to support other provincial health initiatives and improve understanding of health care system performance. Through the integration of previously fragmented data sets and effective guidelines, BCEHS is helping to improve patient outcomes— no matter where their journey starts. Plus, read the story from PHSA!