Focus Where It Matters: Design and Implementation of a Physiology‐Based Care Pathway for Traumatic Shock
Michael Noonan, Joseph Mathew, Simon Hendel, Andrew Underhill, Jean‐Philippe Miller, Alexa Cass, Hector Thomson, Holly Bannon‐Murphy, Mark FitzgeraldABSTRACT
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.