title: Trauma team oversight improves efficiency of care and augments clinical and economic outcomes.
abstract: BACKGROUND
  The purpose of this study was to determine whether trauma team oversight of patient management would positively affect efficiency of care as defined by improved patient throughput, with augmentation of both clinical and economic outcomes.
  
  
  METHODS
  All patients activating the trauma team at a level I trauma center during two time periods (last 6 months of 2005 and 2006) were reviewed. Trauma team activation criteria remained constant across the two time periods. During period one, patients were admitted to multiple services depending on injury pattern, whereas in period two, most patients were admitted to the trauma service for trauma team oversight of their management. In period two, improved documentation and appropriate coding were encouraged. Data are reported as mean +/- SD, and median.
  
  
  RESULTS
  Patient demographics, number of full-time trauma surgeons, and payer mix were similar during the two time periods. Trauma activations increased 150% (p < 0.05). The percentage of patients admitted to the trauma service increased (68% vs. 86%, p < 0.001). Median injury severity score (ISS) of admitted patients was unchanged, although mean ISS decreased (15 +/- 15 vs. 12 +/- 11, p < 0.0001). Hospital length of stay decreased (12 +/- 55 vs. 6 +/- 11, p < 0.0001). Linear regression analysis identified ISS and admission during the later time period as significant predictors of decreased length of stay. Changes in billings and coding practices resulted in statistically significant increases in trauma surgeon work-related relative value units (182% increase), charges (360% increase), and collections (280% increase). The increased system efficiency resulted in significant decreases in the actual hospital costs per patient and led to the generation of an overall net positive hospital contribution margin per patient.
  
  
  CONCLUSIONS
  Implementation of trauma team oversight of patient care resulted in increased efficiency of care delivery, with shorter hospital lengths of stay despite increased patient volume. This paradigm change, coupled with improved documentation and coding, resulted in improved reimbursement for the physician, and lower cost per discharge for the hospital.
authors.affiliation: Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies, Yale University School of Medicine, New Haven, Connecticut 06520-8062, USA. kimberly.davis@yale.edu
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Davis
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Cabbad
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Schuster
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Kaplan
authors.forename: Carla
authors.initials: C
authors.lastname: Carusone
authors.forename: Tucker
authors.initials: T
authors.lastname: Leary
authors.forename: Robert
authors.initials: R
authors.lastname: Udelsman
mesh_terms: D015998:Abbreviated Injury Scale; D003237:Connecticut; D003362:Cost-Benefit Analysis / Q000191:economics; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational / Q000191:economics*; D005251:Fees, Medical / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D009104:Multiple Trauma / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration*; D010557:Personnel Administration, Hospital / Q000191:economics*; D011785:Quality Assurance, Health Care / Q000191:economics / Q000458:organization & administration*; D014193:Trauma Centers / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data