Impact of a Dedicated Trauma Service on the Quality and Cost of Care Provided to Injured Patients at an Urban Teaching Hospital

Cohen, Max M.; Fath, John A.; Chung, Richard; Ammon, Adelaide A.; Matthews, Jennifer H.

doi:10.1097/00043860-199907000-00005

Cited by 4 publications

(5 citation statements)

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“…21,49,50 However, other studies described larger salary expenses in case of an IHTS, although without adjusting for potential reduced process-related costs. [51][52][53][54][55] Future research should investigate the cost-effectiveness of an IHTS.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies reported a reduction in patient costs after introducing an IHTS as a result of enhanced process-related outcomes 21,49,50 . However, other studies described larger salary expenses in case of an IHTS, although without adjusting for potential reduced process-related costs 51–55 . Future research should investigate the cost-effectiveness of an IHTS.…”

Section: Discussionmentioning

confidence: 99%

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In-house versus on-call trauma surgeon coverage: A systematic review and meta-analysis

Mar

Lokerman

Waalwijk

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:A rapid trauma response is essential to provide optimal care for severely injured patients. However, it is currently unclear if the presence of an in-house trauma surgeon affects this response during call and influences outcomes. This study compares in-hospital mortality and process-related outcomes of trauma patients treated by a 24/7 in-house versus an on-call trauma surgeon. METHODS:PubMed/Medline, Embase, and CENTRAL databases were searched on the first of November 2020. All studies comparing patients treated by a 24/7 in-house versus an on-call trauma surgeon were considered eligible for inclusion. A meta-analysis of mortality rates including all severely injured patients (i.e., Injury Severity Score of ≥16) was performed. Random-effect models were used to pool mortality rates, reported as risk ratios. The main outcome measure was in-hospital mortality. Process-related outcomes were chosen as secondary outcome measures. RESULTS:In total, 16 observational studies, combining 64,337 trauma patients, were included. The meta-analysis included 8 studies, comprising 7,490 severely injured patients. A significant reduction in mortality rate was found in patients treated in the 24/7 in-house trauma surgeon group compared with patients treated in the on-call trauma surgeon group (risk ratio, 0.86; 95% confidence interval, 0.78-0.95; p = 0.002; I 2 = 0%). In 10 of 16 studies, at least 1 process-related outcome improved after the in-house trauma surgeon policy was implemented. CONCLUSION:A 24/7 in-house trauma surgeon policy is associated with reduced mortality rates for severely injured patients treated at level I trauma centers. In addition, presence of an in-house trauma surgeon during call may improve process-related outcomes. This review recommends implementation of a 24/7 in-house attending trauma surgeon at level I trauma centers. However, the final decision on attendance policy might depend on center and region-specific conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In-house versus on-call trauma surgeon coverage: A systematic review and meta-analysis

Mar

Lokerman

Waalwijk

et al. 2021

J Trauma Acute Care Surg

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“…It was not possible to determine the policy regarding the presence physicians in the ED of the six hospitals. A number of studies have reported the impact of institutional differences on the outcomes for trauma patients admitted to the ED and subsequent hospitalization [18].…”

Section: Discussionmentioning

confidence: 99%

Involvement of Surgical Residents in the Management of Trauma Patients in the Emergency Room: Does the Presence of an Attending Physician Affect Outcomes?

et al. 2012

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“…After the implementation of such systems, various studies have been carried out to evaluate their effect and most of them have shown that they have contributed to improvement in trauma care and reduction in trauma-related mortality. [8][9][10][11][12][13][14][15][16][17] The utilisation of intensive care is one of the important aspects of a trauma care system. In fact, managing trauma patients in the intensive care unit has been practised all over the world.…”

Section: Impact Of Enhanced Intensive Carementioning

confidence: 99%

The Impact of Enhanced Intensive Care on Outcome of Major Trauma Patients in a Regional Hospital in Hong Kong

Chan¹,

Lit²

2008

Hong Kong Journal of Emergency Medicine

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Objectives To describe an updated epidemiology of major trauma cases presenting to a regional hospital in Hong Kong and to analyse the impact of enhanced intensive care on the outcome of major trauma patients. Methods This was a retrospective comparative study. In late 2004, we amended our trauma care system with enhancement of intensive care in the management of major trauma patients. An 18-month period was chosen before and after the amendment respectively and patients' data and crude mortality rate between the two periods were compared. Stratified analyses based on mechanism of injury, injury severity and physiological parameters were also performed. Finally, a TRISS analysis was included. Results Altogether 163 and 155 patients were included in our study from the two periods respectively. The majority involved blunt injury and one third of them had injury severity score (ISS) greater than 15. Road traffic accidents and fall from height remained as the two leading causes of major trauma. The median length of stay in the intensive care unit increased for one day (p<0.01) in the later period but the median total length of stay in hospital remained the same. The mortality rate decreased from 10.4% to 9.7% (p=0.82). Conclusion With enhanced intensive care, there is an apparent decrease in mortality of major trauma patients but its significance needs to be determined with a larger scale study.

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Impact of a Dedicated Trauma Service on the Quality and Cost of Care Provided to Injured Patients at an Urban Teaching Hospital

Cited by 4 publications

References 0 publications

In-house versus on-call trauma surgeon coverage: A systematic review and meta-analysis

In-house versus on-call trauma surgeon coverage: A systematic review and meta-analysis

Involvement of Surgical Residents in the Management of Trauma Patients in the Emergency Room: Does the Presence of an Attending Physician Affect Outcomes?

The Impact of Enhanced Intensive Care on Outcome of Major Trauma Patients in a Regional Hospital in Hong Kong

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