A systematic review of hybrid emergency interventional room systems (HEIRS) and their effect on patient outcomes

To summarize current data and review cost-benefit analyses of hybrid emergency interventional room systems (HEIRS) and explore the advantages of its implementation in US trauma centers.

Background: Conventional trauma care logistics involves patient transport from the field to the trauma bay for evaluation and resuscitation within the Emergency Room (ER). Most patients undergo CT scanning and subsequently are transferred to surgery or an angiography suite for further treatment. Each transfer requires time, which may delay life-saving procedures. A combined system could mitigate time loss in transfer of critical patients. Proposed and implemented hybrid operating suites have demonstrated decreased patient morbidity and mortality through this concept. Both the Hybrid Emergency Room System (HERS) in Japan and RAPTOR in Canada have demonstrated the benefits of these systems through decreased work-up time and decreased mortality, primarily by reduced deaths from exsanguination. A similar system implemented in tertiary trauma centers across the US could prove to be financially and medically prudent.

Clinical Findings/Procedure Details: Japanese and Canadian cohort studies conducted during the past decade have demonstrated a clear survival benefit in critically injured blunt trauma patients treated using hybrid systems. One study revealed that patients who received care via the hybrid workflow were twice as likely to be alive one month after their hospitalization as compared to those treated with conventional workflows. Subsequent studies have demonstrated that increased survival is directly correlated with time to intervention. The hybrid approach to trauma reduced the time from presentation to intervention by 30-40%, which translated directly into lives saved. A cost analysis of Japanese HEIRS found an incremental cost-effectiveness ratio (ICER) of $32,522 when comparing HEIRS to conventional workflows. Repurposing existing suites reportedly cost $1.2-$5 million. Multi-purpose use of hybrid suites among specialties could accelerate cost-saving benefits and improve opportunities for future refinancing.

Conclusion and/or Teaching Points: In trauma settings where “time is life”, transport delays life-saving procedures. Aggregate review data shows that hybrid systems improve patient morbidity and mortality. Additionally, the cost-benefit analyses of these systems demonstrate long-term financial savings over initial investment. Given its international financial and clinical benefits, the implementation of hybrid systems in level 1 trauma centers across the United States is likely prudent.