Focus Where It Matters: Design and Implementation of a Physiology‐Based Care Pathway for Traumatic Shock
5 affiliations
- 1National Trauma Research Institute Melbourne Australia
- 2Trauma Service, The Alfred Hospital Melbourne Australia
- 3Emergency & Trauma Centre, The Alfred Hospital Melbourne Australia
- 4School of Translational Medicine, Monash University Australia
- 5Department of Anaesthesiology and Perioperative Medicine The Alfred Hospital Melbourne Australia
Abstract
Objective: Traumatic shock lacks a consensus definition, and in blunt‐predominant systems its causes are heterogeneous. Simple physiological parameters remain the most universally available basis for early recognition. We describe the design and staged implementation of a physiology‐based care pathway for traumatic shock and evaluate its implementation through staff experience.
Methods: Single‐centre quality‐improvement and implementation project at an Australian Level 1 trauma centre, reported per SQUIRE 2.0. The pathway comprised physiology‐based activation (systolic blood pressure ≤ 90 mmHg, shock index > 1, prehospital blood or senior clinician concern), structured pre‐arrival preparation, trauma bay and equipment standardisation, task‐based team roles, prioritised life‐saving interventions and senior‐led disposition, supported by simulation and embedded quality improvement. Components were implemented between June and November 2022. Evaluation comprised pre‐intervention (2021) and post‐implementation (2025) staff surveys, summarised as top‐box favourability, with cross‐sectional characterisation of the shocked cohort. Clinical effectiveness was not assessed.
Results: Of 3667 major trauma patients, 324 (8.8%) met shocked trauma criteria; these patients were younger, more severely injured and had markedly higher mortality (emergency department death 6.8% vs. 0.4%). Favourable ratings of trauma bay equipment and environment rose from approximately one‐quarter to 87.0%. Post‐implementation, staff reported high favourability for timely life‐saving interventions (88.9%), pathway embedding (85.2%) and role confidence (86.5%). Leadership clarity, communication and reliable debriefing did not improve and were identified as ongoing targets.
Conclusions: A physiology‐based traumatic shock pathway was feasibly implemented and embedded, with high staff‐reported readiness and clear targets for refinement. Effectiveness remains to be established.
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BibTeX
@article{noonan2026focus,
title = {{Focus Where It Matters: Design and Implementation of a Physiology‐Based Care Pathway for Traumatic Shock}},
author = {Michael Noonan and Joseph Mathew and Simon Hendel and Andrew Underhill and Jean‐Philippe Miller and Alexa Cass and Hector Thomson and Holly Bannon‐Murphy and Mark Fitzgerald},
journal = {Emergency Medicine Australasia},
year = {2026},
month = nov,
doi = {10.1111/1742-6723.70391},
url = {https://doi.org/10.1111/1742-6723.70391},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Focus Where It Matters: Design and Implementation of a Physiology‐Based Care Pathway for Traumatic Shock
AU - Michael Noonan
AU - Joseph Mathew
AU - Simon Hendel
AU - Andrew Underhill
AU - Jean‐Philippe Miller
AU - Alexa Cass
AU - Hector Thomson
AU - Holly Bannon‐Murphy
AU - Mark Fitzgerald
PY - 2026
DA - 2026/11/04
JO - Emergency Medicine Australasia
DO - 10.1111/1742-6723.70391
UR - https://doi.org/10.1111/1742-6723.70391
AB - Objective: Traumatic shock lacks a consensus definition, and in blunt‐predominant systems its causes are heterogeneous. Simple physiological parameters remain the most universally available basis for early recognition. We describe the design and staged implementation of a physiology‐based care pathway for traumatic shock and evaluate its implementation through staff experience. Methods: Single‐centre quality‐improvement and implementation project at an Australian Level 1 trauma centre, reported per SQUIRE 2.0. The pathway comprised physiology‐based activation (systolic blood pressure ≤ 90 mmHg, shock index > 1, prehospital blood or senior clinician concern), structured pre‐arrival preparation, trauma bay and equipment standardisation, task‐based team roles, prioritised life‐saving interventions and senior‐led disposition, supported by simulation and embedded quality improvement. Components were implemented between June and November 2022. Evaluation comprised pre‐intervention (2021) and post‐implementation (2025) staff surveys, summarised as top‐box favourability, with cross‐sectional characterisation of the shocked cohort. Clinical effectiveness was not assessed. Results: Of 3667 major trauma patients, 324 (8.8%) met shocked trauma criteria; these patients were younger, more severely injured and had markedly higher mortality (emergency department death 6.8% vs. 0.4%). Favourable ratings of trauma bay equipment and environment rose from approximately one‐quarter to 87.0%. Post‐implementation, staff reported high favourability for timely life‐saving interventions (88.9%), pathway embedding (85.2%) and role confidence (86.5%). Leadership clarity, communication and reliable debriefing did not improve and were identified as ongoing targets. Conclusions: A physiology‐based traumatic shock pathway was feasibly implemented and embedded, with high staff‐reported readiness and clear targets for refinement. Effectiveness remains to be established.
SN - 1742-6731
SN - 1742-6723
ER -