title: Academic time at a level 1 trauma center: no resident, no problem?
abstract: BACKGROUND
  Globally, the compliance of resident work-hour restrictions has no impact on trauma outcome. However, the effect of protected education time (PET), during which residents are unavailable to respond to trauma patients, has not been studied. We hypothesized that PET has no impact on the outcome of trauma patients.
  
  
  METHODS
  We conducted a retrospective review of relevant patients at an academic level I trauma center. During PET, a trauma attending and advanced practice providers (APPs) responded to trauma activations. PGY1, 3, and 4 residents were also available at all other times. The outcome of new trauma patient activations during Thursday morning 3-hours resident PET was compared with same time period on other weekdays (non-PET) using a univariate and multivariate analysis.
  
  
  RESULTS
  From January 2005 to April 2010, a total of 5968 trauma patients were entered in the registry. Of these, 178 patients (2.98%) were included for study (37 PET and 141 non-PET). The mean injury severity score (ISS) was 16.2. Although no significant difference were identified in mortality, complications, or length of stay (LOS), we do see that length of emergency department stay (ED-LOS) tends to be longer during PET, although not significantly (314 vs 381 minutes, p = 0.74). On the multiple logistic regression model, PET was not a significant factor of complications, LOS, or ED-LOS.
  
  
  CONCLUSIONS
  Few trauma activations occur during PET. New trauma activations can be staffed safely by trauma activations and APPs. However, there could be some delays in transferring patients to appropriate disposition. Additional study is required to determine the effect of PET on existing trauma inpatients.
authors.affiliation: Division of Trauma, Acute Care and Critical Care Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA 17036, USA. kmatsushima@hmc.psu.edu
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Dickinson
authors.forename: Eric W
authors.initials: EW
authors.lastname: Schaefer
authors.forename: Scott B
authors.initials: SB
authors.lastname: Armen
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Frankel
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000639:trends; D016001:Confidence Intervals; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010414:Pennsylvania; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014193:Trauma Centers / Q000458:organization & administration; D000078329:Workforce; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*