The Red Blanket Protocol in a tertiary centre in Aotearoa New Zealand: does this trauma protocol improve time to surgery and clinical outcomes?

• Published in: ANZ journal of surgery 2022-07, Vol.92 (7-8), p.1714-1723
• Main Authors: Mohamed, Fardowsa, Grinlinton, Megan, Henshall, Kevin, Cox, Murray, MacCormick, Andrew D.
• Format: Article
• Language: English
• Subjects: abdominal aortic aneurysm; Adult; Algorithms; Aortic aneurysms; Blood; Blood products; Clinical outcomes; Emergency medical care; Emergency medical services; Emergency Service, Hospital; haemodynamic shock; Humans; New Zealand - epidemiology; Patients; red blanket protocol; Retrospective Studies; Skin; Surgery; Survival; Trauma
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.17878

Background Patients who are haemodynamically unstable from surgical emergencies require prompt surgical intervention, and delay to surgery may lead to poorer clinical outcomes. The Red Blanket Protocol (RBP) is a communication algorithm intended to facilitate surgery as expediently and safely as possible. By developing a protocol for these channels of communication, RBP may reduce the time to surgical intervention and improve patient outcomes. Our aim was to identify whether patient outcomes, including time to surgery, blood product use and survival were improved by the Red Blanket protocol. Methods Haemodynamically unstable adults in Middlemore Hospital, Aotearoa New Zealand from 1/1/2014 to 31/12/2015 were compared with RBP patients from 1/4/2017 to 1/4/2020. Time from emergency department (ED) to knife‐to‐skin (KTS) was compared between the groups. The number of blood products used, LOS and 30‐ and 90‐day survival were also compared between the pre‐protocol and RBP groups. Results Thirty‐two patients were identified in the pre‐protocol group, and 25 in the RBP group. The median time from ED to KTS reduced from 84 to 70.5 min after the implementation of RBP (P = 0.044). The median number of blood products was 21 pre‐protocol and 11.5 in the RBP group (P = 0.102). The median LOS was 8 versus 4 days in the RBP group (P = 0.204). 30‐day survival rate was comparable in the two groups (65% versus 60% (P 0.71)). Conclusion RBP was associated with a shorter time to knife‐to‐skin for haemodynamically unstable patients. There was no significant difference in clinical outcomes between the two groups. Larger studies are required to assess clinical outcomes of the RBP. Patients who are haemodynamically unstable from surgical emergencies require prompt surgical intervention. The Red Blanket Protocol (RBP) is a flowchart of communication intended to facilitate such patients receiving surgery as expediently and safely as possible. RBP at our institution was associated with a shorter time to OT and knife‐to‐skin.