Trauma center maturation: quantification of process and outcome.
OBJECTIVE
The regional trauma system with the trauma center as its center is a model for health care networks. However, trauma center maturation has not been defined in the literature. The authors' hypothesis was that maturation of the trauma center would affect quantitatively both process and patient outcome.


METHODS
A total of 15,303 trauma patients were admitted from 1987 to 1995. Annual admissions increased from 813 to 2669. Resources were generated as patient volume increased. Time to the operating room, length of stay, and complications were determined. TRISS methodology was used to calculate z scores and w values to compare actual with predicted mortality rates.


RESULTS
Time to the operating room for laparotomy decreased from 62+/-73 to 35+/-47 minutes, from 32+/-32 to 20+/-17 minutes in hypotensive patients, and for craniotomy decreased from 88+/-54 to 67+/-49 minutes. The incidence of infectious, airway, neurologic, orthopedic, respiratory, gastrointestinal, and procedure-related complications declined significantly. Z scores and w values increased for penetrating and blunt injuries. Deaths for patients with ISS >15 declined significantly. Hospital length of stay decreased for all ranges of injury severity.


CONCLUSIONS
As the trauma center matured, the process of delivering patient care became more efficient. The result was improved survival, fewer complications, and a shorter length of stay.
Peitzman
A B
AB
Department of Surgery, University of Pittsburgh Medical Center, PA, USA.
Courcoulas
A P
AP
Stinson
C
C
Udekwu
A O
AO
Billiar
T R
TR
Harbrecht
B G
BG
D017598:Efficiency, Organizational; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D013996:Time and Motion Studies; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy