THE INTEGRATED TRAUMA PROGRAM - A MODEL FOR COOPERATIVE TRAUMA TRIAGE

The Integrated Trauma Program (ITP) is the cooperative trauma triage service of the University of Toronto trauma and bum hospitals and the Ontario Ministry of Health. It provides physicians in referring hospitals direct access to a trauma team leader (TTL) in one of several trauma centers through a single phone number. Three adult trauma centers, one pediatric trauma center, and one bum center, all affiliated with the University of Toronto, participate in this program. This article describes the system during the first two years of operation. From July 1989 to June 1991, 1530 requests for patient transfers from a total of 97 hospitals were processed. Of these transfer requests, 77% were accepted by the TTL to a trauma service as multiple trauma cases, 16% were accepted directly to a surgical service without involving the trauma team, 4% were refused by the TTL as inappropriate referrals, and 3% of requests were cancelled by the referring physician. The transfer requests are distributed to a specific trauma center by request of the referring physician (10%), according to a rotation (70%), or as selected by the ITP (20%) when the scheduled hospital is not readily available. Closure of all adult trauma centers occurred on 43 occasions. During these closures, 48 patients bypassed the Toronto trauma centers and were transferred to other cities. The ITP office also keeps an ongoing data base of patients transferred. The mechanism of injury in the majority of cases is vehicular crashes. The mean injury Severity Score is 24 for adults and 17 for children. During the first two years of operation the ITP has provided a simple, rapid, and effective service for trauma referrals. Some of the frustration faced by referring physicians forced to make multiple enquiries in order to place a trauma patient has been removed. Cooperation among trauma centers for sharing the distribution of trauma cases has resulted in no appreciable change in trauma volumes at each of the centers. The system allows for efficient use of all trauma center resources. This program serves as a model for cooperative trauma case triage and distribution.