title: Trauma service cost: the real story.
abstract: OBJECTIVE
  The objective was to define and characterize the costs associated with trauma care at a level I trauma center. Once the costs were identified, attending physician-led teams were designed to reduce costs within each cost center.
  
  
  BACKGROUND
  The location and magnitude of the costs on a trauma service remain largely unknown. Focused cost-containment strategies remain difficult to implement because the expected return on these interventions is unknown.
  
  
  METHODS
  Cost center data were reviewed for the 40 major DRGs admitted for the first 6 months of the fiscal years 1996 and 1997. Data were obtained from the hospital finance department using the Transition Systems Inc. accounting system. We focused on variable direct costs, those that vary with patient volume (e.g., staff nursing expense and medical/surgical supplies). To address issues of inflation, pay raises, and changing costs, a proxy value was created for 1996 and costs were held constant for the 1997 calculation. The major services that constitute cost centers identified in the system were nursing, surgical, pharmacy, laboratory, radiology, and emergency services. Attendings were assigned to develop and oversee customized cost-reduction modalities specific to each cost center. The cost-reduction modalities used to achieve significant savings were as follows: nursing, case management approach focusing on early discharge; surgical, meeting with operating room (OR) purchasing to modify expensive behavior patterns; pharmacy, integrating clinical pharmacist with direct attending support; laboratory, enforcing protocol for lab draws; radiology, increasing the use of emergency room ultrasound and accepting outside x-rays; and emergency services, 24-hour in-house attending staff to reduce emergency room time. The surgical and emergency services cost centers predominately generate costs by the length of time care is delivered in that area.
  
  
  RESULTS
  For each period, data from 363 patients were compared. Mean length of stay decreased between the study periods from 8.72 to 7.06 days, while the average injury severity score was unchanged. Together, these cost centers constituted 87.4% of the total cost of care delivered. Significant cost reduction was achieved in all six variable cost centers: nursing (24%), surgical (5%), pharmacy (57%), laboratory (27), radiology (7%), and emergency (36). The mean cost per case was reduced by 25%.
  
  
  CONCLUSIONS
  Identification of the true cost centers and directed attending surgeon involvement are essential to the development and implementation of a successful cost-reduction process.
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Taheri
authors.forename: W L
authors.initials: WL
authors.lastname: Wahl
authors.forename: D A
authors.initials: DA
authors.lastname: Butz
authors.forename: L H
authors.initials: LH
authors.lastname: Iteld
authors.forename: A J
authors.initials: AJ
authors.lastname: Michaels
authors.forename: L C
authors.initials: LC
authors.lastname: Griffes
authors.forename: L J
authors.initials: LJ
authors.lastname: Greenfield
mesh_terms: D003361:Cost Allocation; D003363:Cost Control; D019033:Delivery of Health Care, Integrated / Q000191:economics; D006302:Health Services Research; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D008824:Michigan; D014193:Trauma Centers / Q000191:economics*