title: Influence of in-house attending presence on trauma outcomes and hospital efficiency.
abstract: BACKGROUND
  The influence of in-house (IH) attendings on trauma patient survival and efficiency measures, such as emergency department length of stay (LOS), ICU LOS, and hospital LOS, has been debated for more than 20 years. No study has definitively shown improved outcomes with IH vs home-call attendings. This study examines trauma outcomes in a single, Level I trauma center before and after the institution of IH attending call.
  
  
  METHODS
  Patient data were collected from the University of Kentucky's trauma registry. Based on the Trauma-Related Injury Severity Score, survival rates were compared between the IH and home-call groups. To evaluate efficiency, emergency department LOS, ICU LOS, and hospital LOS were compared. A separate subanalysis for the most severely injured patients (trauma alert red) was also performed.
  
  
  RESULTS
  The home-call group (n = 4,804) was younger (p = 0.018) and had a higher Injury Severity Score (p = 0.003) than the IH group (n = 5259), but there was no difference in Trauma-Related Injury Severity Score (p = 0.205) between groups. In-house attending presence did not reduce mortality. Emergency department LOS, ICU LOS, and hospital LOS were shorter during the IH period. Emergency department to operating room time was not different. There was no change in trauma alert red mortality with an attending present (20.7% vs 18.2%, p = 0.198).
  
  
  CONCLUSIONS
  In-house attending presence does not improve trauma patient survival. For the most severely injured patients, attendings presence does not reduce mortality. In-house coverage can improve hospital efficiency by decreasing emergency department LOS, hospital LOS, and ICU LOS.
authors: Division of General Surgery, Section of Acute Care Surgery, University of Kentucky College of Medicine, Lexington, KY.
authors: Jessica A
authors: JA
authors: Cox
authors: Division of General Surgery, Section of Acute Care Surgery, University of Kentucky College of Medicine, Lexington, KY.
authors: Andrew C
authors: AC
authors: Bernard
authors: Division of General Surgery, Section of Acute Care Surgery, University of Kentucky College of Medicine, Lexington, KY.
authors: Anthony J
authors: AJ
authors: Bottiggi
authors: Division of General Surgery, Section of Acute Care Surgery, University of Kentucky College of Medicine, Lexington, KY.
authors: Phillip K
authors: PK
authors: Chang
authors: Division of General Surgery, Section of Acute Care Surgery, University of Kentucky College of Medicine, Lexington, KY.
authors: Cynthia L
authors: CL
authors: Talley
authors: Division of General Surgery, Section of Acute Care Surgery, University of Kentucky College of Medicine, Lexington, KY.
authors: Brian
authors: B
authors: Tucker
authors: Division of General Surgery, Section of Acute Care Surgery, University of Kentucky College of Medicine, Lexington, KY.
authors: Daniel L
authors: DL
authors: Davenport
authors: Division of General Surgery, Section of Acute Care Surgery, University of Kentucky College of Medicine, Lexington, KY. Electronic address: pakear0@uky.edu.
authors: Paul A
authors: PA
authors: Kearney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D020445:Hospitalists; D006801:Humans; D015601:Injury Severity Score; D007629:Kentucky; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*; D055815:Young Adult