Impact of a trauma bypass protocol on a receiving Emergency Department: a 4-year review

Abstract

Aims
In May 2019, Dublin Midland Hospital Group and National Ambulance Service introduced an "Orthopaedic/trauma bypass protocol" to ensure that patients with isolated long bone fractures are transported to a hospital with specialised orthopaedic surgical services on site. This study aimed to evaluate the impact of this protocol on the activity and resource utilisation at Tallaght University Hospital (TUH) Emergency Department (ED).

Methods
A retrospective review of all patients conveyed by ambulance to TUH ED under the trauma bypass protocol between January 2020 and February 2025 was conducted. Demographic, injury, and outcome data were extracted from hospital systems. Primary outcomes included ED and hospital length of stay (LOS), discharge destination and mortality.

Results
Of 57,264 ambulance attendances, 1,636 (2.9%) were trauma bypass cases. The mean age was 60.1 years; 979 patients (59.8%) sustained injuries due to low-level falls. ED LOS averaged 10.2 hours; 1,037 (63.4%) of patients were admitted, with a mean hospital LOS of 15.3 days. A total of 37 patients (2.3%) died during admission, and 110 patients (10.3%) required convalescence or long-term care.

Conclusion
While the bypass protocol improved access to specialist care, it placed considerable demands on TUH. Refinement of triage criteria and improved repatriation pathways are needed to support sustainable trauma system implementation.