Abstract text (incl. references and figure legends)
Introduction
Critical haemorrhage is a potentially preventable cause of in-hospital death after injury. While a systematic approach to initial assessment as per ATLS© protocol has reduced the prevalence of this outcome over the last 30 years, a baseline of 10-12% of in-hospital haemorrhage deaths had been reached in New Zealand (NZ). Taking the position that this was an avoidable event, a quality improvement approach was initiated to reduce haemorrhage deaths
Methods
Using a collaborative quality improvement methodology to engage stakeholders, a Code Crimson notification system was developed and refined. This ensured relevant staff were notified as soon as practicable and were available in the Emergency Department to make decisions about the patient disposition when a patient with severe shock was arriving. Simultaneously, the massive haemorrhage protocol was modified to ensure maximum haemostatic content and appropriate fluid volumes. Both changes were introduced into all 20 trauma hospitals in NZ. The protocol was adapted for small, medium and large hospitals.
Results
Compared to the previous 4 years, in 2022 in-hospital haemorrhage related death dropped from 11.4% to 5.6%. Using a risk adjusted methodology there was no difference in the risk of haemorrhage deaths between these time periods. In addition, the overall number of trauma deaths in NZ was reducing at the same time
Conclusions
In-hospital haemorrhage death is largely preventable. Use of a contemporary massive haemorrhage protocol and a system which ensures decision-makers are immediately available to correctly implement haemostatic interventions can significantly reduce in-hospital haemorrhage death.
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