title: The general surgery model: a more appealing and sustainable alternative for the care of trauma patients.
abstract: The contemporary model of trauma care where dedicated trauma/critical care surgeons exclusively manage trauma patients has become progressively unsustainable. Little objective data, however, is available documenting that a better model exists. From September 2002 through August 2003, the trauma model at a 735-bed level I trauma teaching hospital was changed from the contemporary model to a new one where selected general surgeons with Advanced Trauma Life Support (ATLS) certification covered in-house trauma and emergency surgery call on a rotational basis. As well, each pursued elective practices, admitting all inpatients (trauma, emergent, elective) to a single teaching service (formerly the trauma service). Critical care was managed by a separate group of intensivists. The purpose of this study was to objectively compare the two models. Quantitative, financial, and qualitative data were derived from August 2001 to January 2002 (trauma/critical care model) and compared to August 2003 to January 2004 (general surgery model). During the two periods (trauma/critical care vs general surgery), the mean Revised Trauma Score (7.1 vs 7.2; P = 0.029), the mean Injury Severity Score (ISS) (10.9 vs 10.8; P = 0.84), and the percentage of penetrating trauma (12.5% vs 13.2%; P = 0.79) were similar. Differences (trauma/critical care vs general surgery, % increase/P value) included average daily census (24 vs 54, 225%), cases/attending (262 vs 543, 207%), cases/resident (54 vs 262, 485%), charges/attending (353,811 dollars vs 471,725 dollars, 133%), collections/attending (106,143 dollars vs 165,103 dollars, 156%), number of trauma patients (643 vs 748, 116%), trauma mortality (7.3% vs 4.0%; P = 0.007), trauma mortality with ISS >15 (21.7% vs 12.0%; P = 0.035), trauma complications (33.1% vs 17%; P < 0.001), and ICU morbidity (66.8% vs 43.9%; P < .001). The new general surgery model produced superior financial results and better quantitative surgical experience while exceeding trauma and ICU quality outcomes compared to the former trauma/critical care model. These data objectively support a model such as ours--one that is financially sustainable and more professionally attractive.
authors.affiliation: Academic Department of Surgery, Greenville Hospital System, 701 Grove Road, Greenville, SC 29605, USA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Roettger
authors.forename: Spence M
authors.initials: SM
authors.lastname: Taylor
authors.forename: Jerry R
authors.initials: JR
authors.lastname: Youkey
authors.forename: Dawn W
authors.initials: DW
authors.lastname: Blackhurst
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013022:South Carolina; D013043:Specialties, Surgical / Q000191:economics / Q000592:standards*; D015599:Trauma Severity Indices; D014194:Traumatology / Q000592:standards; D014947:Wounds and Injuries / Q000191:economics / Q000601:surgery*