Effects of a nonsurgical hospitalist service on trauma patient outcomes.
BACKGROUND
The American College of Surgeons criteria for Level I trauma centers calls for >90% of trauma patients to be admitted directly by a trauma surgeon or surgical subspecialist; however, the efficiency of the trauma system may be increased if patients presenting with comorbid conditions and minor injuries are treated by a hospitalist team (nonsurgical Trauma MEDical [TMED] service). We hypothesized outcomes would be equivalent for patients treated under TMED versus a surgical service.


METHODS
This retrospective review compared mortality, hospital length of stay (LOS), Emergency Department (ED) LOS, placement to rehabilitation facilities, and complication rates for patients who could have been treated by TMED as identified by an algorithm. The study population for 2003 (pre-TMED) was compared with the study population for 2006 (post-TMED). Univariate analyses and multivariate logistic and linear regression were used to identify outcomes that were different for patients treated in 2003 versus 2006. Sensitivity, specificity, and percent kappa agreement were calculated for patients who were treated by the TMED team in 2006 versus patients in 2006 who were identified using the algorithm.


RESULTS
The algorithm had reasonable sensitivity (78%) and specificity (90%); the kappa agreement was excellent (0.88). No differences were found in mortality (P = .31), rate of complications (P = .08), ED LOS (P = .77), or placement to rehabilitation facilities (P = .29) for patients identified in 2003 versus 2006. Hospital LOS was increased in 2006 (3.7 vs 4.1 days; P = .02).


CONCLUSIONS
These data support admission of trauma patients with nonsevere, single-system injuries to a nonsurgical hospitalist service. We hypothesize that overall system efficiency may be improved by applying this alternative model in other trauma centers.
Salottolo
Kristin
K
Trauma Research Department, Swedish Medical Center, Englewood, CO 80113, USA.
Slone
Denetta Sue
DS
Howell
Patricia
P
Settell
April
A
Bar-Or
Raphael
R
Craun
Michael
M
Bar-Or
David
D
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003120:Colorado / Q000453:epidemiology; D020445:Hospitalists; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013043:Specialties, Surgical; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy