"After-hours" staffing of trauma centres and outcomes among patients presenting with acute traumatic coagulopathy.
OBJECTIVE
To examine the effect of the "after-hours" (18:00-07:00) model of trauma care on a high-risk subgroup - patients presenting with acute traumatic coagulopathy (ATC).


METHODS
Retrospective analysis of data from the Alfred Trauma Registry for patients with ATC presenting between 1 January 2006 and 31 December 2011.


METHODS
Mortality at hospital discharge, adjusted for potential confounders, describing the association between after-hours presentation and mortality.


RESULTS
There were 398 patients with ATC identified during the study period, of whom 197 (49.5%) presented after hours. Mortality among patients presenting after hours was 43.1%, significantly higher than among those presenting in hours (33.1%; P = 0.04). Following adjustment for possible confounding variables of age, presenting Glasgow Coma Scale score, urgent surgery or angiography and initial base deficit, after-hours presentation was significantly associated with higher mortality at hospital discharge (adjusted odds ratio, 1.77; 95% CI, 1.10-2.87).


CONCLUSIONS
The after-hours model of care was associated with worse outcomes among some of the most critically ill trauma patients. Standardising patient reception at major trauma centres to ensure a consistent level of care across all hours of the day may improve outcomes among patients who have had a severe injury.
The Alfred Hospital, Melbourne, VIC, Australia. biswadev.mitra@monash.edu.
Biswadev
B
Mitra
Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Peter A
PA
Cameron
The Alfred Hospital, Melbourne, VIC, Australia.
Mark C B
MC
Fitzgerald
The Alfred Hospital, Melbourne, VIC, Australia.
Stephen
S
Bernard
The Alfred Hospital, Melbourne, VIC, Australia.
John
J
Moloney
The Alfred Hospital, Melbourne, VIC, Australia.
Dinesh
D
Varma
The Alfred Hospital, Melbourne, VIC, Australia.
Huyen
H
Tran
The Alfred Hospital, Melbourne, VIC, Australia.
Martin
M
Keogh
D000208:Acute Disease; D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D000368:Aged; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D014739:Victoria / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications