Commitment to COT verification improves patient outcomes and financial performance.
BACKGROUND
After an unsuccessful American College of Surgery Committee on Trauma visit, our level I trauma center initiated an improvement program that included (1) hiring new personnel (trauma director and surgeons, nurse coordinator, orthopedic trauma surgeon, and registry staff), (2) correcting deficiencies in trauma quality assurance and process improvement programs, and (3) development of an outreach program. Subsequently, our trauma center had two successful verifications. We examined the longitudinal effects of these efforts on volume, patient outcomes and finances.


METHODS
The Trauma Registry was used to derive data for all trauma patients evaluated in the emergency department from 2001 to 2007. Clinical data analyzed included number of admissions, interfacility transfers, injury severity scores (ISS), length of stay, and mortality for 2001 to 2007. Financial performance was assessed for fiscal years 2001 to 2007. Data were divided into patients discharged from the emergency department and those admitted to the hospital.


RESULTS
Admissions increased 30%, representing a 7.6% annual increase (p = 0.004), mostly due to a nearly fivefold increase in interfacility transfers. Severe trauma patients (ISS >24) increased 106% and mortality rate for ISS >24 decreased by 47% to almost half the average of the National Trauma Database. There was a 78% increase in revenue and a sustained increase in hospital profitability.


CONCLUSIONS
A major hospital commitment to Committee on Trauma verification had several salient outcomes; increased admissions, interfacility transfers, and acuity. Despite more seriously injured patients, there has been a major, sustained reduction in mortality and a trend toward decreased intensive care unit length of stay. This resulted in a substantial increase in contribution to margin (CTM), net profit, and revenues. With a high level of commitment and favorable payer mix, trauma center verification improves outcomes for both patients and the hospital.
Maggio
Paul M
PM
Department of Surgery, Stanford University School of Medicine, Stanford, California 94305, USA. pmaggio@stanford.edu
Brundage
Susan I
SI
Hernandez-Boussard
Tina
T
Spain
David A
DA
D015998:Abbreviated Injury Scale; D000328:Adult; D003362:Cost-Benefit Analysis / Q000191:economics; D017598:Efficiency, Organizational / Q000191:economics*; D005251:Fees, Medical / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics; D008297:Male; D009104:Multiple Trauma / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration*; D010557:Personnel Administration, Hospital / Q000191:economics*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration; D014481:United States / Q000453:epidemiology; D014600:Utilization Review