title: In-house trauma attendings: a new financial benefit for hospitals.
abstract: BACKGROUND
  There is an intuitive belief that in-house trauma attendings benefit patient outcome, although multiple studies have failed to prove this. However, no studies investigate the financial advantage for hospitals by having the attendings also perform urgent general surgery cases (GSC) during nights and weekends. The purpose of this study is to identify how an in-house attending program was used for urgent GSC and to see if it provided a financial benefit to the hospital.
  
  
  METHODS
  The in-house program began in October 2007. A retrospective study reviewed all cholecystectomies performed from October 2006 to September 2007 and October 2007 to September 2008. Total length of stay (LOS) was calculated. Total LOS for each group was multiplied by the daily cost for a medical-surgical bed ($2,530.00). The cost difference was calculated for the pre- and post-in-house groups.
  
  
  RESULTS
  Two hundred sixty-four cholecystectomies were performed before instituting an in-house attending program compared with 291 cases in the period after a 9% increase. Total LOS for cholecystectomies performed before the program was 6.4 days translating to $16,192.00 in room costs versus 5.24 days after and $13,257.20 in room costs. This translated to a savings of $2,934.80 per patient and $854,026.80 savings in total because of reduced LOS, which subsidized the cost of the program, which was $750,000.00.
  
  
  CONCLUSIONS
  In-house attendings are beneficial in decreasing overall LOS for urgent GSC. This study demonstrates that in-house attendings can perform urgent GSCs and realize a savings for a hospital that can be used to fully subsidize the cost of the program.
authors.affiliation: Department of General Surgery, New York University Medical Center, Bellevue Hospital Center, New York, New York 10016, USA. dultzl01@nyumc.org
authors.forename: Linda A
authors.initials: LA
authors.lastname: Dultz
authors.forename: H Leon
authors.initials: HL
authors.lastname: Pachter
authors.forename: Ronald
authors.initials: R
authors.lastname: Simon
mesh_terms: D039602:After-Hours Care / Q000458:organization & administration; D000704:Analysis of Variance; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006302:Health Services Research; D006748:Hospital Departments / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D009519:New York City; D009551:Night Care / Q000458:organization & administration; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D015397:Program Evaluation; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration; D014194:Traumatology / Q000458:organization & administration*