Time and motion: a study of trauma surgeons' work at the bedside during the first 24 hours of blunt trauma care.
BACKGROUND
The current literature defines the costs of trauma care in terms of hospital costs and charges. We sought to define the qualitative and quantitative labor costs of trauma care by measuring the various components of bedside care provided by surgeons at a community hospital.


METHODS
We conducted a prospective time-and-motion study during the initial 24 hours of blunt trauma patients' stay in the hospital at a Level II trauma center. The services provided by two surgeons and one nurse practitioner were examined. All patients were resuscitated and seen initially by one of the physicians. Ten service elements (SEs) were defined, and total time (TT) spent was the sum of time spent on all service elements for that patient. We defined labor cost as TT. Data on Injury Severity Score (ISS), alcohol intoxication, length of stay, operative procedures, and injury mechanism were also collected. Data are in minutes as means +/- SEM. Analysis of linear correlation was by Pearson correlation coefficient, and intergroup comparison of means was by two-tailed t test.


RESULTS
Fifty-eight patients were studied. Mean ISS and length of stay were 11.8 +/- 3 and 4.6 +/- 3 days, respectively. A mean of seven SEs were provided per patient, and the number of SEs provided correlated directly with ISS (r = 0.75, p < 0.01). The mean TT spent was 171 +/- 9 minutes, and it correlated directly with ISS (r = 0.64, p < 0.01). For patients undergoing operative procedures by the trauma surgeon, the procedures consumed the greatest portion of TT: 73 +/- 6 minutes (24%). For patients not undergoing operative procedures, resuscitation and time spent in the radiology department consumed the majority of TT: 30 minutes for each SE (40% of TT). Serum ethanol was greater than 0.10 in 33 of 58 patients (57%), and these patients required significantly more TT (135 vs. 193 minutes; p < 0.05) than nonintoxicated patients.


CONCLUSIONS
A significant labor cost (TT) was required for the care of blunt trauma patients, and the majority of that cost was not spent in the operating room but involved the performance of cognitive services. Significant correlation existed between ISS and labor cost. The presence of ethanol intoxication significantly increased this commitment. These data might be of use in creating provider reimbursement schemes for trauma care. This methodology may have applications in the design of hospital systems for trauma care.
Grossman
M D
MD
Department of Surgery, University of Pennsylvania Trauma Network, Philadelphia, USA.
Schwab
C W
CW
Chu-Rodgers
S
S
Kestner
M
M
D000435:Alcoholic Intoxication / Q000150:complications; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D009722:Nurse Practitioners; D013996:Time and Motion Studies; D014194:Traumatology / Q000458:organization & administration / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery / Q000628:therapy*