The Effect of Implementation of the Standard Clinical Practice Guideline (CPG) for Management of Multiple Trauma Patients Admitted to an Emergency Department

  • Farhad Heydari Department of Emergency Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
  • Mohammad Hosein Maghami Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  • Mehrdad Esmailian Department of Emergency Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
  • Majid Zamani Department of Emergency Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Keywords: Clinical protocols, Emergency service; hospital, Multiple trauma, Triage


Introduction: The purpose of triage in the standard Clinical Practice Guide (CPG) for multiple trauma patients is to perform the primary and secondary evaluations in the quickest and shortest possible time with minimal errors and the best quality in the emergency department (ED). Objective: In this study, a practical program for a coordinated management of multiple trauma patients in the ED has been provided by using the CPG guide. The impact of its implementation on the multiple trauma patients’ management was evaluated. Methods: This is a cross-sectional study conducted in 2014 and 2015 in Isfahan’s Al-Zahra hospital ED. Administration and management of multiple trauma patients had been prepared before the implementation of the plan based on standard clinical methods of implementation in a way that used a 12-step protocol for the practical guide. This protocol was designed as a flowchart and the results before and after its implementation were evaluated. Results: In this study, 100 multiple trauma patients before and after the implementation of the protocol were studied. The mean age of the patients and other baseline characteristics of studied patients in the two periods before and after implantation of the CPG were not significantly different (p > 0.05). The frequency of intubation (p = 0.016) and sent to the operating room (p < 0.001) were different in the two study periods. However, hospitalization in the ICU (p = 0.35) and death (p = 0.73) before and after implementation of the protocol were not statistically different. The time before examination by the EM physicians was significantly lower in all triage levels after CPG implementation. Meanwhile, no change in time elapsed occurred for the surgeons except for the patients in level 2 of triage. Conclusion: Implementation of the strategic plan of CPG lead to a significant reduction in waiting time for visits by emergency medicine services and other specialized services, increased the deployment of patients needing surgery, and reducing the time spent in the ED.


1. Azami-Aghdash S, Sadeghi-Bazargani H, Shabaninejad H, Abolghasem Gorji H. Injury epidemiology in Iran: a systematic review. J Inj Violence Res. 2017;9(1):27-40.
2. Sadeghi-Bazargani H, Ayubi E, Azami-Aghdash S, Abedi L, Zemestani A, Amanati L, et al. Epidemiological Patterns of Road Traffic Crashes During the Last Two Decades in Iran: A Review of the Literature from 1996 to 2014. Arch Trauma Res. 2016;5(3):e32985.
3. Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C, Joshipura M. Emergency medical systems in low- and middle-income countries: recommendations for action. Bull World Health Organ. 2005;83(8):626-31.
4. Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernandez-Frackelton M, et al. Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med. 2004;11(1):38-50.
5. Derlet RW, Kinser D, Ray L, Hamilton B, McKenzie J. Prospective identification and triage of nonemergency patients out of an emergency department: a 5-year study. Ann Emerg Med. 1995;25(2):215-23.
6. Arhami-Dolatabadi A, Maleki M, Memary E, Kariman H, Shojaee M, Baratloo A. The use of emergency department services for non-emergency conditions. Health MED. 2017;11(1):3-9.
7. Baratloo A, Maleki M. Iranian emergency department overcrowding. JEPT. 2015;1(2):39.
8. Hashemi B, Baratloo A, Forouzafar MM, Motamedi M, Tarkhorani M. Patient satisfaction before and after executing health sector evolution plan. Ir J Emerg Med. 2015;2(3):127-33.
9. Eitel DR, Rudkin SE, Malvehy MA, Killeen JP, Pines JM. Improving service quality by understanding emergency department flow: a White Paper and position statement prepared for the American Academy of Emergency Medicine. J Emerg Med. 2010;38(1):70-9.
10. Zohoor A, Pilevarzadeh M. Study of speed of offering services in emergency department at Kerman Bahonar hospital in 2000. Razi J Med Sci. 2003;10(35):413-9.
11. Banerjea K, Carter AO. Waiting and interaction times for patients in a developing country accident and emergency department. Emerg Med J. 2006;23(4):286-90.
12. Burgers JS, Grol R, Klazinga NS, Makela M, Zaat J. Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual Health Care. 2003;15(1):31-45.
13. Baratloo A, Mirbaha S, Bahreini M, Banaie M, Safaie A. Outcome of Trauma Patients Admitted to Emergency Department Based on Full Outline of Unresponsiveness Score. Adv J Emerg Med. 2017;1(1):e2.
14. Hashemi B, Amanat M, Baratloo A, Forouzanfar MM, Rahmati F, Motamedi M, et al. Validation of CRASH Model in Prediction of 14-day Mortality and 6-month Unfavorable Outcome of Head Trauma Patients. Emergency. 2016;4(4):196-201.
15. Cooke MW, Wilson S, Pearson S. The effect of a separate stream for minor injuries on accident and emergency department waiting times. Emerg Med J. 2002;19(1):28-30.
16. Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. Jama. 1999;281(20):1900-5.
How to Cite
Heydari, F., Maghami, M. H., Esmailian, M., & Zamani, M. (2017). The Effect of Implementation of the Standard Clinical Practice Guideline (CPG) for Management of Multiple Trauma Patients Admitted to an Emergency Department. Advanced Journal of Emergency Medicine, 2(1), e5.
Original article