General surgery residents improve efficiency but not outcome of trauma care.
BACKGROUND
Current American College of Surgeons Level I trauma center verification requires the presence of a residency program in which trauma care is an integral part of the training. The rationale for this requirement remains unclear, with no scientific evidence that resident participation improves the quality of trauma care. The purpose of this study was to determine whether quality or efficiency of trauma care is influenced by general surgery residents.


METHODS
Our urban Level I trauma center has traditionally used 24-hour in-house postgraduate year-4 general surgery residents in conjunction with at-home trauma attending backup to provide trauma care. As of July 1, 2000, general surgery residents no longer participated in trauma patient care, leaving sole responsibility to an in-house trauma attending. Data regarding patient outcome and resource use with and without surgery resident participation were tabulated and analyzed. Continuous data were compared using Student's t test if normally distributed and the Mann-Whitney U test if nonparametric. Categorical data were compared using chi2 analysis or Fisher's exact test as appropriate.


RESULTS
During the 5-month period with resident participation, 555 trauma patients were admitted. In the identical time period without residents, 516 trauma patients were admitted. During the period without housestaff, patients were older and more severely injured. Mechanism was not different during the two time periods. Mortality was not affected; however, time in the emergency department and hospital lengths of stay were significantly shorter with residents. Multiple regression confirmed these findings while controlling for age, mechanism, and Injury Severity Score.


CONCLUSIONS
Although resident participation in trauma care at a Level I trauma center does not affect outcome, it does significantly improve the efficiency of trauma care delivery.
Offner
Patrick J
PJ
Trauma Service, Saint Anthony Central Hospital, Denver, Colorado 80204, USA. patrickoffner@centura.org
Hawkes
Allison
A
Madayag
Robert
R
Seale
Fred
F
Maines
Charles
C
D000328:Adult; D013502:General Surgery / Q000193:education*; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007396:Internship and Residency; D007902:Length of Stay; D010043:Outcome and Process Assessment, Health Care; D012044:Regression Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality / Q000601:surgery*