title: Nontrauma surgeons can safely take call at an academic, rural level I trauma center.
abstract: BACKGROUND
  Care protocols can facilitate effective management of injured patients across a spectrum of providers. It is uncertain whether patient care is compromised when a full time trauma surgeon is not on call in the rural setting, where manpower may be a challenge.
  
  
  METHODS
  A retrospective cohort study was performed at an academic medical center with a level I trauma center. Patients admitted to the trauma service from 2007 to 2012 were compared with respect to mortality, missed injuries, delay in diagnosis, and length of stay based on whether they were admitted to the trauma service when a full-time trauma surgeon was on call.
  
  
  RESULTS
  A total of 2,571 injured patients were admitted during the study period; 1,621 directly to the trauma service. Of those, 1,415 patients were initially seen by a trauma surgeon (group A) and 206 by a nontrauma surgeon (group B). Demographics were similar except that the trauma attending patients were somewhat older (44.7 vs 39.4 years, P = .002). There was no difference in the mean injury severity score (17.0 vs 16.0, P = .13) or Glasgow Coma Scale (12.7 vs 12.3, P = .7) between the 2 groups. There were 128 deaths; mortality rate in group A was 7.9% versus 7.7% for group B (P = .54). There was no difference in the incidence of delayed diagnosis or missed injuries (3.0 vs 3.4%, P = .8; .4 vs .9%, P = .27, respectively). The mean length of stay was shorter (7.9 vs 6.3, P = .016) in group B.
  
  
  CONCLUSIONS
  There was no increase in mortality, delayed diagnosis, or missed injuries when nontrauma surgeons took call. Systems of care and algorithms can be developed that provide staffing flexibility yet maintain safe and effective care to trauma patients in the rural setting.
authors: Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors: Nathan
authors: N
authors: Louras
authors: Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors: John
authors: J
authors: Fortune
authors: Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
authors: Turner
authors: T
authors: Osler
authors: Department of Surgery, University of Chicago Medicine, 5841 S Maryland Avenue, Chicago, IL 60637, USA. Electronic address: nhyman@surgery.bsd.uchicago.edu.
authors: Neil
authors: N
authors: Hyman
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005260:Female; D006780:Hospitals, Rural / Q000592:standards; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000600:supply & distribution*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D066231:Surgeons / Q000600:supply & distribution*; D014193:Trauma Centers / Q000592:standards; D014707:Vermont; D000078329:Workforce; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
keywords: Night call; Rural; Safety; Trauma center