Impact of a dedicated trauma service on the quality and cost of care provided to injured patients at an urban teaching hospital.
BACKGROUND
To determine the impact of a dedicated trauma service on cost and quality of care in an urban teaching hospital, a before-and-after study was designed. The key elements of the trauma service were dedicated in-house trauma attending surgeons and residents, and continuity and integration of trauma care.


METHODS
Injury Severity Scores and probabilities of survival for each patient were calculated from the hospital International Classification of Diseases, Ninth Revision, codes, and individual patient costs were estimated from charges using the Medicare Cost Report.


RESULTS
The trauma service resulted in a significant increase in the severity of injuries. There was a highly significant (p<0.001) increase in the mean probability of death (from 0.16 to 0.21). There was no change in actual mortality. Although the mean cost of care increased by 16.6%, there were small reductions in the cost of care of the most severely injured patients.


CONCLUSIONS
A dedicated trauma service has a positive impact on the quality of care.
Cohen
M M
MM
Department of Surgery, Grace Hospital, Detroit, MI, USA. mmc3060@bjcmail.carenet.org
Fath
J A
JA
Chung
R S
RS
Ammon
A A
AA
Matthews
J
J
D000328:Adult; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D017721:Hospital Costs; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D014193:Trauma Centers / Q000191:economics* / Q000592:standards*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000145:classification