Impact of the in-house trauma surgeon on initial patient care, outcome, and cost.
BACKGROUND
The purpose of this study is to evaluate the effect of having attending trauma surgeons with added qualifications in surgical critical care present for the initial resuscitation at a regional trauma center.


METHODS
This study is a retrospective review of patients admitted between August of 1994 and December of 1995 from our trauma registry. The patients were categorized by the call preference of the admitting physician as in-house (IH) or call-back from home (CB), day of admission (weekend vs. weekday), time of admission (AM VS. PM), and a value of the injury severity scale < or = 15 or > 15. Demographics, admission vital signs, Injury Severity Scale, Glasgow Coma Score, and elapsed time to diagnostic, therapeutic, and/or operative interventions were studied. The effect on intensive care unit length of stay, mortality, and hospital cost for resuscitation were also studied.


RESULTS
The study population consisted of 1,043 patients. The IH and CB groups each included two attending surgeons. IH significantly reduced the average time to completion of diagnostic peritoneal lavage (22 vs. 34 minutes; p < 0.05), therapeutic intervention (21 vs 38 minutes; p < 0.05), and transport to the operating room (206 vs. 312 minutes; p < 0.05) during the AM compared with CB. There was no difference in these times for the PM admissions. There was no significant difference in intensive care unit length of stay. Among patients with severe head and thoracoabdominal injury (Abbreviated Injury Score > 4 and 3, respectively) there was no difference in mortality. Analysis of cost for emergency room resuscitation in severely injured patients (Injury Severity Score > or = 15), seen during weekdays, was significantly less when evaluated by IH (IH = $5,097 vs. CB = $6,779; p < 0.05).


CONCLUSIONS
During the initial resuscitation of patients with severely injured during the weekdays, IH significantly reduced the cost, and elapsed time to diagnostic testing, therapeutic intervention, and to the operating room, respectively. IH reduced fatalities compared with CB.
Luchette
F
F
Department of Surgery, University of Cincinnati College of Medicine, OH 45267-0558, USA.
Kelly
B
B
Davis
K
K
Johanningman
J
J
Heink
N
N
James
L
L
Ottaway
M
M
Hurst
J
J
D000328:Adult; D003627:Data Interpretation, Statistical; D005069:Evaluation Studies as Topic; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D013043:Specialties, Surgical; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality / Q000601:surgery* / Q000628:therapy