title: To everything there is a season: impact of seasonal change on admissions, acuity of injury, length of stay, throughput, and charges at an accredited, regional burn center.
abstract: OBJECTIVE
  Although previous studies have investigated the impact of weather and temporal factors on incidence of trauma admissions, there is a paucity of data describing the effect of seasonal change on burn injury. The purpose of this study was to examine the impact of the changing seasons on admissions to and resource utilization at an accredited burn center, with the goal of optimizing patient throughput and matching supply with demand.
  
  
  METHODS
  We performed a retrospective review of all burn admissions to an accredited, regional burn center, from Summer 2009 through Spring 2010. Patients were segregated into the seasonal cohorts of Summer, Fall, Winter, and Spring, based on admission date. Patient demographics included age, gender, mechanism of injury, and total body surface area (TBSA) injured. Main outcome measures included length of intensive care unit (ICU) stay, length of stay (LOS), and hospital charges, which served as a proxy for resource utilization (nursing, wound, and critical care; access to operating room (OR); inpatient rehabilitation). Groups were compared by T tests, with statistical significance assigned to P values <0.05.
  
  
  RESULTS
  Seven hundred thirty patients were admitted to the burn center during this annual period, with a mean age of 31.6 years and a TBSA of 8.9%. Although Spring had the greatest the number of admissions at 219 (30%), patients from Summer and Winter had the largest burns, longest length of ICU and hospital stays, and highest hospital charges (P < 0.05). Furthermore, variability of these parameters, as measured by standard deviation, was greatest during Summer and Winter, serving to reduce throughput via uneven demand on resources. Highest throughput occurred during the Spring, which had the highest admission-to-LOS ratio. No differences were observed in age, gender, and incidence of electrical injuries, across the 4 seasons.
  
  
  CONCLUSIONS
  Summer and winter were the peak seasons of resource utilization at our burn center, in terms of length and variability of ICU and hospital stays, as well as total hospital charges. Such seasonal change may be related to acuity of burn injury but not number of burn admissions. To improve operational efficiency and maximize patient throughput, resource allocation should be structured to anticipate seasonal changes, so that supply of services matches demand.
authors.affiliation: Division of Plastic Surgery, University of North Carolina Health Care System, Chapel Hill, NC 27516-7195, USA. cshult@med.unc.edu
authors.forename: C Scott
authors.initials: CS
authors.lastname: Hultman
authors.forename: Winnie T
authors.initials: WT
authors.lastname: Tong
authors.forename: Matthew
authors.initials: M
authors.lastname: Surrusco
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Roden
authors.forename: Michelle
authors.initials: M
authors.lastname: Kiser
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
mesh_terms: D000293:Adolescent; D000328:Adult; D002053:Burn Units / Q000191:economics / Q000706:statistics & numerical data*; D002056:Burns / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002648:Child; D015331:Cohort Studies; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012621:Seasons; D015599:Trauma Severity Indices; D055815:Young Adult