A dedicated craniofacial trauma team improves efficiency and reduces cost.
BACKGROUND
In this era of limited medical resources there is ever increasing pressure to lower costs, while preserving high-quality patient care. A dedicated craniofacial and skull base trauma team (SBT) was established at our Level I trauma center in July 1998. Previously, a rotating call panel of multiple private surgical subspecialists consulted on trauma patients with craniofacial or skull base injuries (Pre-SBT). This study was designed to assess the impact a dedicated craniofacial and skull base trauma team has on the cost and quality of patient care.


METHODS
A retrospective review of the trauma registry and charts was performed including all craniofacial and skull base trauma cases in the 18 months Pre-SBT and 18 months following the establishment of a SBT.


RESULTS
During the Pre-SBT period there were 29 craniofacial and skull base operations, whereas 28 such cases were performed by the SBT. The age, sex, injury severity score (ISS), mechanism of injury, and type of craniofacial/skull base injuries were comparable between groups. The SBT group demonstrated a reduction in the number of patients transferred to other institutions for definitive care (7 vs 1, P = 0.05) and statistically significant reduction in the number of subspecialty consultations (2.4 vs 1.3), time to operation (7.5 vs 3.0 days), and length of hospitalization (11.8 vs 6.8, all with P <or= 0.001). Additionally, hospital charges were markedly reduced in the SBT group (106,424 dollars vs 58,136 dollars, P < 0.01).


CONCLUSIONS
The addition of a dedicated craniofacial trauma team to a Level I trauma center provides more comprehensive care, improves efficiency, and reduces cost.
Mathiasen
R A
RA
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Eby
J B
JB
Jarrahy
R
R
Shahinian
H K
HK
Margulies
D R
DR
D000328:Adult; D003363:Cost Control / Q000379:methods; D006259:Craniocerebral Trauma / Q000191:economics* / Q000601:surgery; D017598:Efficiency, Organizational; D004632:Emergency Medical Services / Q000191:economics / Q000458:organization & administration; D005147:Facial Bones / Q000293:injuries / Q000601:surgery; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000191:economics* / Q000458:organization & administration*; D010360:Patient Transfer / Q000191:economics; D012042:Registries; D012189:Retrospective Studies; D012886:Skull / Q000293:injuries / Q000601:surgery; D014193:Trauma Centers / Q000191:economics* / Q000458:organization & administration*; D014194:Traumatology / Q000191:economics* / Q000458:organization & administration*; D000078329:Workforce