title: The effect of a change in the surgeon response time mandate on outcomes within Ohio level III trauma centers: it is all about commitment.
abstract: BACKGROUND
  The American College of Surgeons Committee on Trauma guidelines for trauma center verification stipulate that the responsible surgeon be present within 15 minutes of the arrival of a critically injured patient. Recently, these guidelines were liberalized, extending the response time to 30 minutes in level III trauma centers. This study evaluated the potential impact of this guideline change on the delivery of care at Ohio's level III trauma centers. We hypothesized that there would be no measurable difference in the emergency department (ED) length of stay (LOS), ED disposition, and facility mortality after enactment of this mandate, which extended the surgeon response time from 15 minutes to 30 minutes at level III trauma centers.
  
  
  METHODS
  Data were collected from the trauma registries of 13 level III trauma centers in Ohio beginning 2 years before and ending 2 years after June 30, 2004, the day the response time was extended to 30 minutes. Statistical analyses were completed comparing the two groups in terms of demographic and clinical characteristics, surgeon response time, ED disposition, ED LOS, and facility mortality.
  
  
  RESULTS
  A total of 1,076 patients were treated during the 4-year period. The type of trauma, age, and Injury Severity Score were similar between the two groups. The mean (+/-SD) surgeon response times before and after the rule change were 14.8 minutes (+/-19.4 minutes) and 15.5 minutes (+/-22.3 minutes), respectively. The two groups also had similar ED LOS (mean = 2.9, median = 2.5 for both groups), rates of transfer to higher level centers (34.4% vs. 32.8%; p = 0.58), and facility mortality rates (10.0% vs. 11.2%; p = 0.55).
  
  
  CONCLUSIONS
  The extension of the surgeon response time from 15 minutes to 30 minutes did not adversely affect the outcomes of trauma patients at Ohio's level III trauma centers. Furthermore, the surgeon response time was similar before and after the rule change.
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, Ohio 45267-0558, USA. angie.ingraham@yahoo.com
authors.forename: Angela
authors.initials: A
authors.lastname: Ingraham
authors.forename: Rakesh
authors.initials: R
authors.lastname: Shukla
authors.forename: Jane
authors.initials: J
authors.lastname: Riebe
authors.forename: M Margaret
authors.initials: MM
authors.lastname: Knudson
authors.forename: Jay
authors.initials: J
authors.lastname: Johannigman
mesh_terms: D000068:Accreditation; D000328:Adult; D003695:Delivery of Health Care / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D019983:Guideline Adherence / Q000458:organization & administration*; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D037141:Mandatory Programs / Q000458:organization & administration; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012042:Registries; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration*; D014194:Traumatology / Q000458:organization & administration*