“Peas in a Pod”: Clustering minorly injured trauma patients together during their hospitalization results in decreased hospital costs and fewer inpatient complications

Bauman, Zachary M.; Cemaj, Sophie L.; Patel, Nishant; Raposo-Hadley, Ashley; Saxton, Karen; Evans, Charity H.; Waibel, Brett H.; Cantrell, Emily

doi:10.1016/j.amjsurg.2022.03.030

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…Although postimplementation we did not add more nursing staff, the skill mix improved, and assignment logistics were adjusted such that each nurse cared for the same distribution of patients by acuity level, with their location on the 20-bed unit also taken into account. In other studies, clustering patients by acuity level and location resulted in fewer falls by improving communication and nursing response times 39, 40. Our acuity-adaptable model reduced patient transfers, improved the nursing skill mix, and redistributed care assignments evenly by patient acuity with consideration for location, all of which likely contributed to the reduction in falls.…”

Section: Discussionmentioning

confidence: 64%

“…In other studies, clustering patients by acuity level and location resulted in fewer falls by improving communication and nursing response times. 39,40 Our acuity-adaptable model reduced patient transfers, improved the nursing skill mix, and redistributed care assignments evenly by patient acuity with consideration for location, all of which likely contributed to the reduction in falls.…”

Section: Discussionmentioning

confidence: 99%

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Original Research: Breaking Through the Bottleneck: Acuity Adaptability in Noncritical Trauma Care

Higgins,

Charles,

Fryman

2024

AJN, American Journal of Nursing

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Background: Achieving efficient throughput of patients is a challenge faced by many hospital systems. Factors that can impede efficient throughput include increased ED use, high surgical volumes, lack of available beds, and the complexities of coordinating multiple patient transfers in response to changing care needs. Traditionally, many hospital inpatient units operate via a fixed acuity model, relying on multiple intrahospital transfers to move patients along the care continuum. In contrast, the acuity-adaptable model allows care to occur in the same room despite fluctuations in clinical condition, removing the need for transfer. This model has been shown to be a safe and cost-effective approach to improving throughput in populations with predictable courses of hospitalization, but has been minimally evaluated in other populations, such as patients hospitalized for traumatic injury. Purpose: This quality improvement project aimed to evaluate implementation of an acuity-adaptable model on a 20-bed noncritical trauma unit. Specifically, we sought to examine and compare the pre- and postimplementation metrics for throughput efficiency, resource utilization, and nursing quality indicators; and to determine the model's impact on patient transfers for changes in level of care. Methods: This was a retrospective, comparative analysis of 1,371 noncritical trauma patients admitted to a level 1 trauma center before and after the implementation of an acuity-adaptable model. Outcomes of interest included throughput efficiency, resource utilization, and quality of nursing care. Inferential statistics were used to compare patients pre- and postimplementation, and logistic regression analyses were performed to determine the impact of the acuity-adaptable model on patient transfers. Results: Postimplementation, the median ED boarding time was reduced by 6.2 hours, patients more often remained in their assigned room following a change in level of care, more progressive care patient days occurred, fall and hospital-acquired pressure injury index rates decreased respectively by 0.9 and 0.3 occurrences per 1,000 patient days, and patients were more often discharged to home. Logistic regression analyses revealed that under the new model, patients were more than nine times more likely to remain in the same room for care after a change in acuity and 81.6% less likely to change rooms after a change in acuity. An increase of over $11,000 in average daily bed charges occurred postimplementation as a result of increased progressive care–level bed capacity. Conclusions: The implementation of an acuity-adaptable model on a dedicated noncritical trauma unit improved throughput efficiency and resource utilization without sacrificing quality of care. As hospitals continue to face increasing demand for services as well as numerous barriers to meeting such demand, leaders remain challenged to find innovative ways to optimize operational efficiency and resource utilization while ensuring delivery of high-quality care. The findings of this study demonstrate the value of the acuity-adaptable model in achieving these goals in a noncritical trauma care population.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Original Research: Breaking Through the Bottleneck: Acuity Adaptability in Noncritical Trauma Care

Higgins,

Charles,

Fryman

2024

AJN, American Journal of Nursing

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“…Lastly, this study demonstrated patients undergoing SSRF were more likely to be discharged home or to an acute rehabilitation center. This is very important as the inability to return to a familiar environment and regain some independent function is associated with a higher incidence of mortality, especially in the elderly 31–34 . The inability to discharge a patient home is also associated with additional financial resource implications to the health care system and patient 31,32,35 …”

Section: Discussionmentioning

confidence: 99%

“…This is very important as the inability to return to a familiar environment and regain some independent function is associated with a higher incidence of mortality, especially in the elderly. [31][32][33][34] The inability to discharge a patient home is also associated with additional financial resource implications to the health care system and patient. 31,32,35 The main outcome for this study was to examine the ROI of SSRF.…”

Section: Discussionmentioning

confidence: 99%

“…[31][32][33][34] The inability to discharge a patient home is also associated with additional financial resource implications to the health care system and patient. 31,32,35 The main outcome for this study was to examine the ROI of SSRF. The patient benefits discussed in the previous paragraphs are extremely important, but it is also important to analyze the economic benefits of SSRF as the authors of this study are not naïve to the cost related to this procedure.…”

Section: Discussionmentioning

confidence: 99%

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Surgical stabilization of rib fractures is associated with better return on investment for a health care institution than nonoperative management

Bauman,

Khan,

Cavlovic

et al. 2023

J Trauma Acute Care Surg

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Introduction Surgical stabilization of rib fractures(SSRF) continues to gain popularity due to patient benefits. However, little has been produced regarding the economic benefits of SSRF and its impact on hospital metrics such as Vizient. The aim of this study was to explore these benefits hypothesizing SSRF will demonstrate positive return on investment(ROI) for a healthcare institution. Methods This is a retrospective review of all rib fracture patients over 5 years at our Level 1 trauma center. Patients were grouped into SSRF versus nonoperative management(NOM). Basic demographics were obtained including case mix index(CMI). Outcomes included narcotic requirements in morphine milliequivalents(MME) prior to discharge, mortality, and discharge disposition. Furthermore, actual hospital length of stay(ALOS) versus Vizient expected LOS were compared between cohorts. Contribution margin(CM) was also calculated. Independent t-test, paired t-test, and linear regression analysis were performed, and significance set at p < 0.05. Results A total of 1,639 patients were included; 230(14%) underwent SSRF. Age, gender, and Injury Severity Score were similar. SSRF patients had more ribs fractured (7 versus 4; p < 0.001) and more patients with flail chest (43.5% versus 6.7%; p < 0.001). SSRF patients also had a significantly higher CMI (4.33 versus 2.78; p = 0.001). Narcotic requirements and mortality were less in the SSRF cohort; 155 versus 246 MME (p < 0.001) and 1.7% versus 7.1% (p = 0.003), respectively. SSRF patients were more likely to be discharged home (70.4% versus 63.7%; p = 0.006). SSRF patients demonstrated shorter ALOS where NOM patients demonstrated longer ALOS compared to Vizient expected LOS. CMs for SSRF patients were significantly higher and linear regression analysis showed a CM $1,128.14 higher per patient undergoing SSRF (p < 0.001) Conclusion Patients undergoing SSRF demonstrate a significant ROI for a healthcare organization. Despite SSRF patients having a higher CMI, they were able to be discharged sooner than expected by Vizient calculations resulting in better a CM. Level of evidence IV, Therapeutic

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Systematic analysis of the occurrence characteristics and impact on hospitalization costs of trauma complications

Chu,

Liu,

Dai

et al. 2024

The American Journal of Surgery

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“Peas in a Pod”: Clustering minorly injured trauma patients together during their hospitalization results in decreased hospital costs and fewer inpatient complications

Cited by 4 publications

References 27 publications

Original Research: Breaking Through the Bottleneck: Acuity Adaptability in Noncritical Trauma Care

Original Research: Breaking Through the Bottleneck: Acuity Adaptability in Noncritical Trauma Care

Surgical stabilization of rib fractures is associated with better return on investment for a health care institution than nonoperative management

Systematic analysis of the occurrence characteristics and impact on hospitalization costs of trauma complications

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