Trauma case management: improving patient outcomes.
BACKGROUND
The purpose of the study was to measure the effect of trauma case management (TCM) on patient outcomes, using practice-specific outcome variables such as in-hospital complication rates, length of stay, resource use and allied health service intervention rates.


METHODS
TCM was provided 7 days a week to all trauma patient admissions. Data from 754 patients were collected over 14 months. These data were compared with 777 matched patients from the previous 14 months.


RESULTS
TCM greatly improved time to allied health intervention (p<0.0001). Results demonstrated a decrease in the occurrence of deep vein thrombosis (p<0.038) and a trend towards decreased patient morbidity, unplanned admissions to the intensive care unit and operating suite. A reduced hospital stay LOS, particularly in the paediatric and 45-64 years age group was noted. Six thousand six hundred twenty-one fewer pathology tests were performed and the total number of bed days was 483 days less than predicted from the control group.


CONCLUSIONS
The introduction of TCM improved the efficiency and effectiveness of trauma patient care in our institution. This initiative demonstrates that TCM results in improvements to quality of care, trauma patient morbidity, financial performance and resource use.
Curtis
Kate
K
St. George Hospital, University of New South Wales, Sydney, NSW, Australia. gkcurtis@bigpond.com
Zou
Yi
Y
Morris
Richard
R
Black
Deborah
D
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D019090:Case Management / Q000458:organization & administration*; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006302:Health Services Research / Q000379:methods; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000458:organization & administration; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control; D014947:Wounds and Injuries / Q000150:complications / Q000175:diagnosis / Q000628:therapy*