Factors Influencing Treatment Delays in Trauma Patients: A Three-delay Model Approach

Abstract

Introduction: Identifying factors causing treatment delays is essential for guiding decisions on resource allocation within trauma systems. The three-delay model categorizes delays into: (i) deciding to seek medical care (Phase 1), (ii) recognizing the need for transporting to a medical facility (Phase 2), and (iii) receiving suitable and timely treatment (Phase 3). We seek to investigate factors influencing delays in trauma patients using the three-delay model. Methods: We conducted an 18-month prospective observational study at a tertiary hospital, involving consenting adults (age >18 years) admitted for various traumas. We conducted a detailed interview and extracted objective patient data from medical records using a predetermined form. We observed and analyzed factors influencing the duration of the three phases. Results: Phase 1 delays were observed in 83 patients, Phase 2 delays in 200 patients, and Phase 3 delays in 233 patients. In Phase 3 delays, a shortage of human resources was the most frequently identified cause of delay, affecting 68 out of 233 patients (29%). In severe trauma cases (injury severity score ≥16), any phase delay showed a significant association with poor outcomes (P < 0.05). Conclusion: The three-delay model offers a valuable framework for understanding and pinpointing the factors contributing to delays in both prehospital and inhospital services.