Staff commitment to trauma care improves mortality and length of stay at a level I trauma center.
BACKGROUND
Optimizing human resources at trauma facilities may increase quality of care. The purpose of this study was to assess whether staffing changes within a Level I trauma center improved mortality and shortened length of stay (LOS) for trauma patients.


METHODS
Mortality, hospital LOS, and intensive care unit LOS were evaluated during three time periods: trauma service coverage by in-house general surgery residents and attendings ("group 1"), the creation of a core trauma panel with in-house trauma surgeons ("group 2"), and the addition of physician assistants (PAs) to the core trauma panel ("group 3"). Logistic regression and chi tests were used to compare mortalities, and multiple linear regression, t-tests, and median tests were used to compare LOS.


RESULTS
There were 15,297 adult patients with trauma included in the analysis. After adjustment for transfers-in, mechanism of injury, injury severity score, age, and head injury, the presence of in-house trauma surgeons (group 2) decreased the following compared with group 1: overall mortality (3.12% vs. 3.82%, p = 0.05), mortality in the severely injured (11.41% vs. 14.83%, p = 0.02), and median intensive care unit LOS (3.03 days vs. 3.40 days, p = 0.006). The introduction of PAs to the core trauma panel (group 3 vs. group 2) decreased overall mortality (2.80% vs. 3.76%, p = 0.05), and reduced mean and median hospital LOS (4.32 days vs. 4.69 days, p = 0.05; and 3.74 days vs. 3.88 days, p = 0.02, respectively).


CONCLUSIONS
The presence of in-house core trauma surgeons and PAs improves management and outcome of critically injured trauma patients within a level I trauma center.
Trauma Services Department, St. Anthony Central Hospital, Denver, Colorado, USA.
Charles
C
Mains
Kristin
K
Scarborough
Raphael
R
Bar-Or
Allison
A
Hawkes
Jeffery
J
Huber
Pamela
P
Bourg
David
D
Bar-Or
D000328:Adult; D001291:Attitude of Health Personnel; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000639:trends*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009723:Nurse-Patient Relations; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010817:Physician-Patient Relations; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy