Access to specialist care: Optimizing the geographic configuration of trauma systems

Jan O. Jansen*, Jonathan J. Morrison, Handing Wang, Shan He, Robin Lawrenson, James D. Hutchison, Marion K. Campbell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


BACKGROUND The optimal geographic configuration of health care systems is key to maximizing accessibility while promoting the efficient use of resources. This article reports the use of a novel approach to inform the optimal configuration of a national trauma system. METHODS This is a prospective cohort study of all trauma patients, 15 years and older, attended to by the Scottish Ambulance Service, between July 1, 2013, and June 30, 2014. Patients underwent notional triage to one of three levels of care (major trauma center [MTC], trauma unit, or local emergency hospital). We used geographic information systems software to calculate access times, by road and air, from all incident locations to all candidate hospitals. We then modeled the performance of all mathematically possible network configurations and used multiobjective optimization to determine geospatially optimized configurations. RESULTS A total of 80,391 casualties were included. A network with only high- or moderate-volume MTCs (admitting at least 650 or 400 severely injured patients per year, respectively) would be optimally configured with a single MTC. A network accepting lower-volume MTCs (at least 240 severely injured patients per year) would be optimally configured with two MTCs. Both configurations would necessitate an increase in the number of helicopter retrievals. CONCLUSION This study has shown that a novel combination of notional triage, network analysis, and mathematical optimization can be used to inform the planning of a national clinical network. Scotland's trauma system could be optimized with one or two MTCs. LEVEL OF EVIDENCE Care management study, level IV.

Original languageEnglish
Pages (from-to)756-765
Number of pages10
JournalJournal of Trauma and Acute Care Surgery
Issue number5
StatePublished - 1 Nov 2015
Externally publishedYes


  • Trauma systems
  • geographic information systems
  • multiobjective optimization


Dive into the research topics of 'Access to specialist care: Optimizing the geographic configuration of trauma systems'. Together they form a unique fingerprint.

Cite this