Optimizing Physician Staffing and Resource Allocation: Sine-Wave Variation in Hourly Trauma Admission Volume

Vaziri, Khashayar; Roland, Jason C.; Robinson, Linda; Fakhry, Samir M.

doi:10.1097/ta.0b013e31803245c7

Cited by 26 publications

(25 citation statements)

References 14 publications

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“…Looking at hourly admission data from the United States National Trauma Data Bank, Vaziri et al 18 observed a sine-wave pattern in the number of patients admitted with a 3.5-fold increase in admissions in the evening hours, with a peak at 7:00 PM, compared with the morning hours. In a series of 9,408 traumas over 6 years, Bhattacharyya et al 19 found a significant relationship between weather and trauma center activity, with temperature and precipitation independently associated with trauma volume.…”

Section: Discussionmentioning

confidence: 99%

Relation of the Weather and the Lunar Cycle With the Incidence of Trauma in the Groningen Region Over a 36-Year Period

Stomp

Fidler

Duis

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Relation of the weather and the lunar cycle with the incidence of trauma in the Groningen region over a 36-year period Stomp, W.; Fidler, V.; ten Duis, H.J.; Nijsten, Maarten W Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Background: The time distribution of injuries is not random. To assess the potential impact of weather and the phase of the moon on accidents, adjustment for known periodic and nonperiodic factors may be important. We compared the incidence of injuries with quantitative and qualitative weather variables as well as the lunar cycle, after correction for calendar and holiday-related factors. Methods:We extracted the daily number of trauma patients treated at the emergency department over 36 years (1970 -2005) from the trauma database of our regional hospital. For each patient, age, sex, cause of injury, and severity of injury were recorded. This was combined with daily meteorological data including temperature, precipitation, sunshine, humidity, air pressure, and wind as well as the lunar phase. We also related the rate of change of these parameters with the incidence of injuries. A qualitative weather variable derived from temperature, sunshine duration, and precipitation was defined as bad, normal, or good. Periodicities were adjusted for with Poisson regression spline fitting analysis. Results: Several weather variables were related with the number of injuries. For most of these, better weather conditions were associated with an increase in trauma incidence. Good weather, which was present on 16.5% of the days, resulted in 10.1% (9.3-11.4 95% CI) more traumas compared with normal weather. Full moon was associated with a 2.1% (1.1-3.0 95% CI) lower trauma incidence than new moon. Conclusions: Better weather conditions contribute to an increased incidence of trauma. Full moon is associated with a slightly lower trauma incidence.

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Section: Discussionmentioning

confidence: 99%

Relation of the Weather and the Lunar Cycle With the Incidence of Trauma in the Groningen Region Over a 36-Year Period

Stomp

Fidler

Duis

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…The only data are from the study by Vaziri et al using the US NTDB, which observed an increase in the ISS of trauma admissions in the early hours. 34 The increased injury severity seen in the early hours may be due to an increased severity of RTCs during this time, with driving speed, alcohol use and fatigue all thought to contribute. 30,35 Further analysis of the mechanism of injury associated with the BSUH admissions would be required for any conclusions to be drawn.…”

Section: Discussionmentioning

confidence: 99%

Temporal variation in major trauma admissions

Kieffer

Michalik

Gallagher

et al. 2016

annals

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INTRODUCTION Trauma is a significant cause of morbidity and mortality in the UK. Since the inception of the trauma networks, little is known of the temporal pattern of trauma admissions. METHODS Trauma Audit and Research Network data for 1 April 2011 to 31 March 2013 were collated from two large major trauma centres (MTCs) in the South East of England: Brighton and Sussex University Hospitals NHS Trust (BSUH) and St George's University Hospitals NHS Foundation Trust (SGU). The number of admissions and the injury severity score by time of admission, by weekdays versus weekend and by month/season were analysed. RESULTS There were 1,223 admissions at BSUH and 1,241 at SGU. There was significant variation by time of admission; there were more admissions in the afternoons (BSUH p<0.001) and evenings (SGU p<0.001). There were proportionally more admissions at the weekends than on weekdays (BSUH p<0.001, SGU p=0.028). There was significant seasonal variation in admissions at BSUH (p<0.001) with more admissions in summer and autumn. No significant seasonal variation was observed at SGU (p=0.543). CONCLUSIONS The temporal patterns observed were different for each MTC with important implications for resource planning of trauma care. This study identified differing needs for different MTCs and resource planning should be individualised to the network.

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“…Emergencies occur without regard for time and require an on-call team to manage them at all hours 2 . The emergent diagnoses may not be straightforward due to confounding of co-morbidities that cannot be optimized prior to operation.…”

Section: Introductionmentioning

confidence: 99%

Does relative value unit–based compensation shortchange the acute care surgeon?

Schwartz¹,

Hui

Velopulos³

et al. 2014

Journal of Trauma and Acute Care Surgery

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BACKGROUND Studies have demonstrated that relative value units (RVUs) do not appropriately reflect cognitive effort or time spent in patient care, but RVU continues to be used as a standardized system to track productivity. It is unknown how well RVU reflects the effort of acute care surgeons. Our objective was to determine if RVUs adequately reflect increased surgeon effort required to treat emergent versus elective patients receiving similar procedures. METHODS A retrospective analysis using The American College of Surgeons’ National Surgical Quality Improvement Program 2011 data set was conducted. The control group consisted of patients undergoing elective colectomy, hernia repair, or biliary procedures as identified by Current Procedural Terminology. Comparison was made to emergent cases after being stratified to laparoscopic or open technique. Generalized linear models and logistic regression were used to assess specific outcomes, controlling for demographics and comorbidities of interest. The RVUs, operative time, and length of stay (LOS) were primary variables, with major/minor complications, mortality, and readmissions being evaluated as the relevant outcomes. RESULTS A total of 442,149 patients in the National Surgical Quality Improvement Program underwent one of the operative procedures of interest; 27,636 biliary (91% laparoscopic; 8.5% open), 28,722 colorectal (40.3% laparoscopic, 59.7% open), and 31,090 hernia (26.6% laparoscopic, 73.4% open) operations. Emergent procedures were found to have average RVU values that were identical to their elective case counterparts. Complication rates were higher and LOS were increased in emergent cases. Odds ratios for complications and readmissions in emergent cases were twice those of elective procedures. Mortality was skewed toward emergent cases. CONCLUSION Our data indicate that the emergent operative management for various procedures is similarly valued despite increased LOS, more complications, higher mortality risk, and subsequently increased physician attention. Our findings suggest that the RVU system for acute care surgeons may need to be reevaluated to better capture the additional work involved in emergent patient care.

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Optimizing Physician Staffing and Resource Allocation: Sine-Wave Variation in Hourly Trauma Admission Volume

Cited by 26 publications

References 14 publications

Relation of the Weather and the Lunar Cycle With the Incidence of Trauma in the Groningen Region Over a 36-Year Period

Relation of the Weather and the Lunar Cycle With the Incidence of Trauma in the Groningen Region Over a 36-Year Period

Temporal variation in major trauma admissions

Does relative value unit–based compensation shortchange the acute care surgeon?

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