title: Optimal deployment of trauma personnel in the 80-hour work week era based on peak times of trauma patient arrival.
abstract: In the 80-hour work week era, optimal distribution of the residency workforce is critical. Little data exist as to whether current hours of hospital staffing parallel trends in trauma activity. The purpose of this study was to determine peak periods of trauma volume, severity, need for operative intervention, and mortality and determine if there are differences in mortality based on time period of arrival. We performed a retrospective analysis of the 17,167 patients admitted to our academic Level I trauma center between 2000 and 2007. Each admission was plotted against time of arrival and trends noted. A significant increase in activity occurred between 1700 and 0100 hours. Compared with other shifts, this shift had a disproportionately higher number of patients with penetrating injuries, need for operative intervention, Injury Severity Score (ISS) greater than 15, and death (P < 0.0001). After adjusting for ISS and penetrating trauma, arrival time was not predictive of mortality (OR 0.97, CI 0.87-1.08, P = 0.6). In conclusion, a peak in trauma activity occurs during an evening shift between 1700 and 0100 hours. In an era of optimizing resident training within the constraints of an 80-hour work week, strong consideration should be made for deploying personnel to match these findings.
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
authors.forename: Arezou
authors.initials: A
authors.lastname: Yaghoubian
authors.forename: Christian
authors.initials: C
authors.lastname: De Virgilio
authors.forename: Laura
authors.initials: L
authors.lastname: Destro
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
authors.forename: Brant
authors.initials: B
authors.lastname: Putnam
authors.forename: Angela L
authors.initials: AL
authors.lastname: Neville
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007396:Internship and Residency / Q000458:organization & administration*; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D010561:Personnel Staffing and Scheduling; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D014194:Traumatology; D000078329:Workforce; D014949:Wounds, Nonpenetrating / Q000401:mortality*; D014950:Wounds, Penetrating / Q000401:mortality*