Analysis of Hospital Ability to Provide Trauma Services: A Comparison between Teaching and Community Hospitals

Abstract

Hypothesis:Teaching hospitals (TH) can maintain the American College of Surgeons Committee on Trauma (ACSCOT) criteria for Level II trauma care more consistently than can community hospitals (CH).Methods:A retrospective analysis of 2,091 trauma system patients was done to determine if TH in an urban area are better able to meet the criteria for Level II trauma care than are CH. During the study period, a voluntary trauma plan existed among five hospitals; two TH and three CH. A hospital could accept patients that met trauma system entry criteria as long as, at that moment, it could provide the resources specified by ACSCOT. Hospitals were required to report their current resources accurately. A centralized communications center maintained a computerized, inter-hospital link which continuously monitored the availability of all participating hospitals. Trauma system protocols required paramedics to transport system patients to the closest available trauma hospital that had all the required resources available. Nine of the required ACSCOT Level II trauma center criteria were monitored for each institution emergency department (ED); trauma surgeon (TS); operating room (OR); angiogaphy (ANG); anesthesiologist (ANE); intensive care unit (ICU); on-call surgeon (OCS); neurosurgeon (NS); and CT scanner (CT) available at the time of each trauma system entry.Results:With the exception of OR, TH generally maintained the required staff and services more successfully than did CH. Further, less day to night variation in the available resources occurred at the TH. Specifically, ANE, ICU, TS, NS and CT were available more often both day and night, at TH than CH. However, OR was less available at TH than CH during both day and night (p<.01).Conclusions:In this community, TH provided a greater availability of trauma services than did CH. This study supports the designation of TH as trauma centers. A similar availability analysis can be performed in other communities to help guide trauma center designation.

Compliance with Closest Hospital Transport Protocol

“…Another analysis of the same hospitals in this study demonstrated significant differences among the hospitals in their ability to provide the trauma services required by the EMS system. 4 Two of die hospitals more successfully maintained the necessary staff and services and had less day-to-night variation in the available resources than did the rest of the participating trauma hospitals. The number of ambulances bypassing other hospitals, and coming to and going away from a specific hospital may have impact on that hospital's ability to provide trauma resources.…”

Computerized Hospital On-Line Resources Allocation Link (CHORAL): A Mechanism to Monitor and Establish Policy for Hospital Ambulance Diversions

“…In response to an increasing incidence of diversions, this community modified a previously developed inter-hospital computer system to monitor availability of trauma hospitals in a voluntary hospital trauma system prior to trauma center designation. 3 That system relied on an interhospital telecommunication system with computers located within the emergency departments of most metropolitan hospitals, all linked to the MRH. In that system, hospitals selected and displayed their respective trauma care status visually on a computer terminal.…”

Development of a pediatric Level 1 trauma center at a freestanding children's hospital: staff attitudes and perceptions before and after trauma designation

“…The reason for abdication of pediatric trauma care by pediatric facilities is complicated and probably multifactorial [6][7][8]. In 1976, the ACS Committee on Trauma published recommended guidelines for developing an organized trauma system to care for the injured patient.…”