title: "Shift work" improves survival and reduces intensive care unit use in seriously injured patients.
abstract: We assessed whether a trauma service model with an emphasis on continuity of care by using "shift work" will improve trauma outcomes and cost. This was a case-control cohort study that took place at a university-affiliated Level I trauma center. All patients (n=4283) evaluated for traumatic injuries between May 1, 2002 and April 30, 2004 were included. During Period I (May 1, 2002 to April 30, 2003), a rotating off-service team provided initial management between 5:00 PM and 7:00 AM. The "day team" provided all other care and was responsible for continuity of care. In Period II (May 1, 2003 to April 30, 2004), a dedicated trauma service consisting of two resident teams evaluated all injured patients. Variables included hospital and intensive care unit length of stay (LOS), mechanical ventilation requirements, hospital mortality, and hospital care costs. Demographics and injury mechanism for both periods were similar, but Injury Severity Score (ISS) in Period II was greater (ISS, 8.2% vs. 7.2%, P < 0.0001; ISS > 15, 18.5% vs. 15.4%). In the more severely injured (ISS > 15), patients in Period II had shorter hospital LOS (8.6 vs. 9.7 days, P = 0.98), a shorter ICU LOS (5.5 vs. 7.7 days, P = 0.039), shorter mechanical ventilator requirements (5.5 vs. 7.7 days, P = 0.32), improved hospital mortality rate (19.9% vs. 26.8%, P = 0.029), and decreased hospital costs (19,146 dollars vs. 21,274 dollars, P = 0.36). On multivariate analysis, factors affecting mortality and LOS included age, initial vital signs, injury type, and ISS. Overall, the two trauma service models resulted in similar outcomes. Although multivariate analysis revealed that treatment period did not affect mortality, our study revealed improved patient survival and reduction in LOS and cost for the severely injured in Period II.
authors.affiliation: Department of Surgery, Room 3082, University of Kansas School of Medicine-Wichita, 929 North Saint Francis Street, Wichita, KS 67214, USA.
authors.forename: Luke Y
authors.initials: LY
authors.lastname: Shen
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Helmer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Huang
authors.forename: Gerayu
authors.initials: G
authors.lastname: Niyakorn
authors.forename: R Stephen
authors.initials: RS
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000191:economics / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D007615:Kansas; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D015996:Survival Rate; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000191:economics* / Q000401:mortality / Q000628:therapy; D014950:Wounds, Penetrating / Q000191:economics* / Q000401:mortality / Q000628:therapy