Critical Care Catalyst: The Impact of Trauma Nurse Leads on Mortality, Patient Outcomes, and Throughput

Background Trauma is the leading cause of years of life lost in the United States. Dedicated trauma nurse leaders (TNLs) coordinate resuscitation and streamline care, but data evaluating their clinical impact at level I trauma centers are limited. We evaluated the association between a newly implemented dedicated TNL program and patient outcomes. Methods This single-center, preimplementation and postimplementation observational study at an urban level I trauma center compared adult tier 1 and tier 2 trauma activations from the pre-TNL period (January 1, 2017, through April 30, 2020) with the post-TNL period (May 1, 2020, through December 31, 2023; 8 dedicated TNLs). The primary outcome was in-hospital mortality (including hospice discharges). Secondary outcomes included time to initial computed tomography (CT), time to operating room, emergency department length of stay (LOS), hospital LOS, and ventilator days. Multivariable logistic regression adjusted for Injury Severity Score (ISS), demographics, payor status, frailty, and activation acuity. Results Of 9112 activations included (pre-TNL, n = 2943; post-TNL, n = 6169), crude in-hospital mortality was unchanged overall (3.53% vs 3.55%; P = .97), but crude mortality decreased significantly among high-severity cohorts: ISS greater than 15 (20.1% vs 12.6%; P < .001), ISS greater than 24 (25.8% to 15.7%; P < .001), and emergent laparotomy (22.2% to 18.5%; P < .001). Median time to CT decreased from 34.48 to 29.64 minutes (P < .001), and mean hospital LOS decreased from 5.57 to 4.93 days (P = .018). After multivariable adjustment, TNL implementation was independently associated with a 36% reduction in odds of in-hospital mortality (adjusted odds ratio = 0.64; 95% CI, 0.48-0.84; P = .001). Conclusion Implementation of a dedicated TNL program was independently associated with significantly lower adjusted in-hospital mortality, driven primarily by survival gains in severely injured patients, faster time to initial diagnostic CT, and reduced hospital length of stay.